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NTTORING WZ.INSTALLATION REPORT <br /> £1 <br /> CONSTRUCTION <br /> Date: <br /> Total Depth (to)_�� <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (to)� <br /> Well No.: Bentonite (from) (to) <br /> Grout (froth) (to) <br /> Inspector: Drilling rig type <br /> Auger O.D. ipe/chriI.D. <br /> Permit No. Completion - Stove pstie box (circle one) <br /> Drslling Company: <br /> casing <br /> Driller: - he;ght <br /> '4 <br /> .Consultant _ �' <br /> Geologist ABOVE-GROUND �y-apX <br /> OOMPLETK3N CCMPLC—ncN <br /> Orcurr3 Su#act <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line <br /> Domestic well on site.- (y/ n) fL <br /> if yes, location and distance- <br /> g <br /> SAMPLIack <br /> NG <br /> Holding Temperature = "'l T <br /> Method <br /> Screening Method <br /> Tracking Shcet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination-Noted- (y/n? <br /> Storage Location Casing type <br /> Blank ft. Screen �• <br /> Slot size <br /> GROU'T'ING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> MixRatios Filter Pack type/size <br /> Mix Ratios <br /> Method Surge Block: - (y/n4Lnst ) <br /> Quantity Installed � Discussed with geologist: - (y/n) <br /> Type of method <br /> EH 29 29• <br />