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Mr--TORING WELL INSTALLATION REPORT <br /> Date: ` CONSTRUCTION <br /> Premise Address: ��2 �`� Total Depth <br /> • ( J Screen Length (from)_S_(to) 2 c' <br /> Well No.: � �Vy Filter Pack (from) 113 (to) 2 y <br /> Bentonite (from) (to) /q <br /> Inspector: Grout (from) I (to) d <br /> n Drilling rig type <br /> pemit No. "I Auger O.D. f I D, <br /> Completion - Stove pip Brie bolt (circle one) <br /> Drilling Company, ����� -- <br /> �v htt hei <br /> Driller. � � 4 <br /> ♦I <br /> Consultant —%V <br /> Geologist ,150NE�ACt ND <br /> C'JM?L ICN CH SY-3CX <br /> C.CMPL-i ICN <br /> W� Ground Sufxs <br /> SPECIAL PERIViIT INFO. <br /> Brat <br /> Distance to sewer line • <br /> Domes dc well on site - ( y %) MN IZ rU ft' <br /> If yes, location and distance Mu Il ft• _ n- <br /> t :. = •3 <br /> Aa C <br /> m <br /> SAMPLING /� �� socion <br /> Vayw pack <br /> Holding Temperature` (J w = <br /> Method w` <br /> Screening Method = <br /> Tracking Sheet y� n) 35 _ c n• <br /> SPOILS <br /> Storage Method MAT cRI.AL.S/DEVELOPMENT <br /> Contamination Noted - ( y nPVA <br /> Storage Location Casing type <br /> Blank Zy ft. Screen ft. <br /> Slot size . d O <br /> GROUTING Bags cement <br /> IBuckets bentonite <br /> Depth to water � �P16 Bags sand/gravel <br /> �Iix Ratios C,�R !�f a W Filter Pack type/size 11 <br /> Installadon Method Surge Block: - (y/'E') <br /> Quantiry Installed Discussed with geologist: - tom/ n ) <br /> ✓r��S Ij Type of method <br /> / I�aj <br />