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lnfIiTORINGWELL INSTALLATION REPOni <br /> �_ <br /> Date: CONSTRUCTION <br /> Premise Address: v� 0 & d4 Total Depth 9 <br /> Screen Length (from) 8.s (to) /3.5 <br /> Well No.: O/Y f ' Filter Pack (from) Cto) <br /> M Bentonite (from) /Z•5 (to) <br /> Inspector: Grout (fro 34 (to) <br /> F Drilling rig type_Z k")-1K -�� 30 <br /> Permit No. U Auger O.D. I.D. ' <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: !/!/ <br /> Driller: Z' 7-` l'e-'W_ t - casing <br /> height: <br /> Consultant_ <br /> Ai;vr:-GROUND . <br /> COMPLETION CHR65 EnOX <br /> LETION <br /> SPECIAL PERNIIT INFO. Ground Surface <br /> grant <br /> Distance to sewer line Cf,15 <br /> Domestic well on site - (y <br /> If yes, location and distance - 2- �• <br /> m <br /> `.r a <br /> 0 <br /> O <br /> slotted <br /> SAMPLING soCson <br /> Holding Temperature �" Y — Vayal! <br /> ack <br /> Method ; <br /> Screening Method 44 <br /> Tracking Sheet - C y/ n ) ,Q�! <br /> SPOILS �'. -•-� ... .,,� � � . �'. $,- ,,,, •�r-•+,t . <br /> Storage Method - MAT ERIALS/DEVELOPMENT ` <br /> Contamination Noted - n w x '� � - <br /> ! - Casing type <br /> Storage Location �� Blank Ls_- ft• Screen - <br /> 3 <br /> Slot size 0/0 <br /> Bags cement <br /> GROUTING , ;. r "` 'Buckets bentonite 1 <br /> :– ( 2. r <br /> .,-Bags <br /> sand gravel <br /> Depth to water t 'L �' Filter Pack type/size Z 2» <br /> Mix Ratios 5` Surge Block: - (y,� <br /> Installations Method -Y.Discussed with geologist: (yam) <br /> Quantity Installed ' <br /> N4 ' Type of method <br /> - EH 2929 <br />