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a �iv TORING WELL INSTALLATION REPO 1 <br /> 11710 <br /> Date: <br /> Date: -z�-o� -- _ -• '� CONSTRUCTION <br /> Total l Depth " <br /> Premise Address: �4. Screen Length (from) /7 S (to) /2,S <br /> Well No.: i4_ <br /> Filter Pack (from) /r (to) !/-S <br /> __/Y� Bentonite (from) s (to) "P95. <br /> Inspector: Grout (from d. t S (to) <br /> O <br /> Drilling rig type "`f'�...a-� -eoL-t 96)00 <br /> Auger O.D. LD. <br /> Permit No. l Completion - Stove pipe/christie box (circle one) <br /> /' <br /> Drilling Company: UU — <br /> casing <br /> Driller• t r ( - height <br /> //''// T <br /> Consultant !eM/ <br /> Geologist ABOVE-GROUND <br /> CHRi.S]Y-80X <br /> CO},SPLETK7N COMPLEnoN <br /> - - Ci=nd Surfw* <br /> SPECIAL PERMIT INFO- <br /> Distance.to sewer line <br /> Domestic well on site - (y <br /> If yes, location and distance - <br /> SAMPLING 4An secjon <br /> Pack <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - n) 1. <br /> . tt. <br /> SPOILS <br /> ". Storage Method -o <br /> Contamination Noted - C y n � J } Casing type <br /> Storage Location x Blank l%.5 -ft. Screen <br /> Slot size <br /> Bags cement , <br /> GR_OUTING Buckets bentonite <br /> Depth to water r ?� <br /> �,. <br /> `.Bags sand/gravel <br /> Filter Pack type/size 2 <br /> Mix RatiosI Surge Block: - (y( 7j <br /> Installation Method - r Discussed with geo y� <br /> Quantity Installed ' <br /> µ k Type of method <br />