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MO BRING WELL INS7AU_A1ION REPORT <br /> Date:_ QL�r- Z''///� /�Q3 CONSI'RUCrON <br /> Prem,se Ad(iress: �7�� d t�l.�-f�'�c Total Depth /s <br /> Screen Length (from) /S/ 2- (to) 9% <br /> Well VIA)/ Filter Pack (from)! (to) <br /> We.l No.:_ _ Bentonite (from) �/z (to) 7 <br /> lnspec-or: Grout (from) 7 (to) o <br /> Drilling rig type z OdSK- / <br /> Permit No. Auger O D. /bE" <br /> '' Complerion- Stove pipe/chrisrie box (circle one) <br /> Drlling Company. ak5a <br /> r.� casing <br /> DrMer: 1.0,/Vv + height <br /> �I Y <br /> Consultant <br /> CGv^e.cQ A3OVEvrROUNO <br /> Geologist C#-StSSY-3CX <br /> CCIAP i1CN P:��CN <br /> Ground Suiws <br /> SPECIAL PERibIIT INFO. <br /> grout <br /> Distance to sewer Iine 41A <br /> Domes tic well on site--(y n) t <br /> If,yes, location and distance - 9 i {L <br /> q�y ft. <br /> SAMPLING <br /> INGgMVW Pack <br /> s�czon — <br /> Holding Temperature tc e <br /> Me_hod <br /> Screening Metahod <br /> Trac'.cing Sheet - n ) <br /> SPOILS <br /> Storage Method OX MA i:.RIALS EVELOPW­NT <br /> Contamination Noted - n) r� <br /> Storage Location y Casing type <br /> Blank y i ft. Screen_ S f <br /> Slot size <br /> GROU 7- NG Bags cemenr <br /> Buckets bentonite 1StLcAA,t <br /> DeDth to water n1 Bags sand/gravel <br /> Mix Rados l AVf'�` 3 ✓ Filter Pack type/size <br /> Ins:ailadon Method Surge Block: - (y/ n}ti1A <br /> Quantity Installed Zb Discussed with geologist: - (y/ n) <br /> Type of method <br /> VU), 11Bl /o-z r-�3 1093 p <br />