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MWFUNG WELL I- ' k-' k ION IREPORT • <br /> Date: " Z Z ( � �y ,/,� CONSiRUCTION�q <br /> IIJhaf- /�"fo Total Depth D (-s <br /> Premise Address: �� P <br /> i <br /> Screen Lenge: (from) - 'J(to) -O <br /> Well No.: Filter Pack (from) 9'T S (to) 7(-Bentonite (from) (to) GR- <br /> Inspector: Grout (from) (o (to)) <br /> Drilling rig type P-�E *7 7 — <br /> Pe..ir No. Auger O.D. (D I.D. <br /> o /2P Completion - Stove pipe/christie box (circle one) <br /> Dr l no Company�� <br /> casing <br /> Driller: �9C�sry Z— height <br /> Consultant L4j <br /> GeologisABOV=--Gr1CUNO CHRSY-BOX <br /> =WFI=i'CN CCMP'LE 1 ICN <br /> G=nd Str1.wv . <br /> SPECIAL. PERMIT INFO. IRR <br /> 9tou2 <br /> Distance to sewer line �`b S L& g <br /> Domestic well on site - ( y/D -7 l <br /> If yes, location and distance - _n <br /> m <br /> 0 <br /> 0 <br /> Clotted = o <br /> SAMPLING wdon � <br /> HoldLna Temperatur <br /> Method tLA <br /> Screening Method <br /> Tracking Sheer - y n ) �,� R ♦ <br /> SPOILS Q <br /> Storage Method 45TX'< """'tg�- '/U�0 MAT-R1.ALS/DEVFLOPME.N7 <br /> Contamination Noted - ( y n q`( &c� <br /> Storage Location Casing type <br /> Blank fr Screen----Z5—ft <br /> Slot size D 2 <br /> GROUTING Bags cement <br /> Buckets bentonite g' <br /> Depth to water <br /> �(� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> lns:alla^on Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - ( y , <br /> Type of method_ <br />