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6441TORING WF•LL INSTALLATION REP0I64d <br /> Date:, Z— CONSRtUCTION <br /> Premise Address:17,1 �, /l Total Depth Z2 <br /> / Screen Length (from) ZZ' (to) 1 <br /> Well No.: Filter Pack (from) Z'2 ' (to) 5- <br /> Bentonite <br /> Bentonite (from) (to)V__ <br /> Inspector: Grout (from) (to) 3' <br /> Drilling rig type S <br /> Permit No. 7, . 2-7 Auger O.D. f,�/x I.D. <br /> Completion-Stove pipe/christie box (circle one) <br /> Drilling Company: O• �S <br /> Driller. casing <br /> Consultant T height <br /> Geologist <br /> ABOVE-GRCUND TV <br /> OOWLETION <br /> SPECIAL PERMIT INFO, Ground Surface <br /> Distance to sewer line grout <br /> Domestic well on site k <br /> y- ( <br /> If yes, location and distance - M <br /> _.Z.tt. <br /> SAMPLI <br /> sedcn _ <br /> Holding Temperature <br /> Method j;-A-&4, _� _ <br /> Screening Method P'Q <br /> Tracking Sheet <br /> SPOILS <br /> Storage Method, C MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y, <br /> Storage Location - Casing type�C�Z <br /> Blank 't t'—ft. Screen /S ft. <br /> Slot size .o•Z-0 <br /> GRA G Bags cement z-/ <br /> Buckets bentonite Z, gzfr <br /> Depth to water - Z Bags sand/gravel el <br /> Mix Ratios Filter Pack type/size <br /> Installation Method ,_ Surge Block: -&�V/ n ) <br /> Quantity Installed Discussed with geo o •st: -(9/ n) <br /> Type of mcthodajj&64v <br /> EH 29 29 <br />