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J — - MG..',ORING WELL INSTALLATION REPORT •J <br /> g 131 3 4It,Pvc <br />' Q (.� p,l Well No.: <br /> Date: o? I �� o` 53 I f CONSTRUCTION <br /> Pemise Address: r �' � f� I Total Depth <br /> Screen Length (from) <br /> `IryVJ \� �( Filter Pack (from) 2�� (to) <br /> Well No.: - <br /> Bentonite (from) (to) <br /> Inspector. ���IeU ' Grout (from) (to) a <br /> //��, p Drilling rig type <br /> Permit No. "I�— I Auger O.D. <br /> -�.(� /� _ Completion - Stove pipe/ tie:bo (cucle ane) <br /> Drilling Co�y: S�" ° 'nu I _ n,,,� •l <br /> Driller: G� CONSTRUCTION Well No.: 'uvW <br /> 3� <br /> Consultant h r�a� ��S� Total Depth <br /> Screen Length (from) 30 (to) <br /> Geoto st Filter Pack (from) 3t2 Cto) $ <br /> ���o`n Bentonite (from)=-- <br /> Grout (from) (to) <br /> Drilling rig type _ <br /> SPECT PERS IjT INFO. Auger O.D. I.D. <br /> Distance to se line Completion - Stove pipe/christie box (circle one) <br /> Domesric well on st - (y/ n) <br /> If yes, location a dis e - <br /> CONS RRUCTION Well No.: <br /> + Total Depth <br /> Screen Length (from) (to) <br /> Filter Pack (from) Cto) <br /> SAMPLING Bentonite - (from) (to) <br /> Grout (from) (to) <br /> Holding Temperature Drilling rig type <br /> Method 5:F\ ' - Auger O.D. I.D. <br /> Screenin_Method i Completion•Stove pipe/chrisde box (circle one) <br /> Tracking Sheet - (��( n) <br /> SPOILS lam/ - <br /> Storage Method J -Z' MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n ) . I- V(1- <br /> a. Storage Location 40 7l� xvuw„ �m8 type <br /> Blank � ft. Screen fr- <br /> _ Slot size 07 <br /> GROUTING Bags cement <br /> Buckets 6entonit <br /> Depth to water �� Bags sand/gravel <br /> Mix Ratios Filter Pack type/siz <br /> Installation Method A Surge Block. - (y <br /> Quantity installed _r Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br />