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N.–,41TORING WELL INSTALLATION REPOR,­., <br /> Date: 1 Z CONSTRUCTION <br /> Premise Address: S U r/�' C G' Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> .Drilling rig type <br /> Permit No, OD Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: ! 11 we �C�j('P <br /> Driller: casing <br /> height <br /> Consultant r'rct t— —EWT <br /> Geologist e Y <br /> ABOVE-GROUND C�WiSTY-8OX <br /> COA�i.I:TION commEnON <br /> tS,PECIAL PERMIT INFO. Qrou r d Surface �.�..r <br /> Distance to sewer line gf°A <br /> Domestic well on site - (y/n} <br /> If yes, location and distance - & <br /> Y O <br /> SAMPLING >,bd _ C <br /> Holding Temperature l N — <br /> Method J t e a U �pack <br /> Screening Method <br /> Tracking Sheet (y/n) <br /> % <br /> SPOILS <br /> Storage Method MATEKAIgMEWLOPMENT <br /> Contamination Noted - (y/ <br /> Storage Location Casing type <br /> Blank ft. Screen fn <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 /> Type of method <br /> EH 29 29 <br />