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—AOMTORING WELL INSTALLATION REP,-.--A <br /> Date: �/ JD CONSTRUCTION <br /> Premise Address:e�D-C? Total Depth ( Zb Ct� <br /> Screen Length (from) (to) <br /> Well No.:G��� Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: ! Grout (from) (to) <br /> Drilling rig type_ , <br /> Permit No. _ Auger O.D. I.D. <br /> Drilling Company: 6"xV <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: cas iAg <br /> height <br /> Consultant �`' � <br /> Geologist '5CO# �Lf <br /> AZO VT_-G ND <br /> COM? {O 1S TY 80X <br /> C 4PL_ETICN <br /> SPECIAL PERMIT INFO. Ground Surlace <br /> Distance to sewer line Ori <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance n <br /> ft. <br /> ft. <br /> C <br /> SAMPLING — <br /> tted — <br /> s on — <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet ( y/ n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) np <br /> Storage Location Casing typeGP( Ov, q <br /> Blank —ftj Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed _ Discussed with geologist: ( y/ n ) <br /> EH 29 29 <br /> Type of method <br /> -- <br />