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- - NITORINGWELL INSTALLATION REPO, <br /> Date:_ b 7�ffi ' 1J CONSTRUCTION <br /> Premise Address: 7-6165, rrw - Total Depth Z 1 <br /> Screen Length (from) (to <br /> Well Na.:_ b S' S� Filter Pack (from) (t <br /> $entonite (from) <br /> Inspector, _ 12-[n. �Cr�� Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Z 1Z Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company. r'^., Q� <br /> Driller:_ <br /> Consultant_ <br /> Geologist I oCpi tr- <br /> (J grout <br /> SPECIAL PERMIT INFO. seal <br /> Distance to sewer line 6f7 ft• <br /> Domestic well.on s' - y/n) <br /> If yes, locati d distance - <br /> gravelpack <br /> ft. <br /> SAMPLING <br /> seal <br /> Holding Temperature csvk i-r„ <br /> Method <br /> Screening Methods <br /> Tracking Shee[ n ) gravel pack <br /> SPOILS �Z ft.• . <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y n) <br /> Storage Location Casing type 3" PV C <br /> Blank t,[h F fs.5 ft. Screen S t ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water N ` Bags sand/gravel - <br /> Mik Ratios cl Filter Pack type/size <br /> installation Method G.—�lL.ou�. �r Surge Block: - <br /> (Y/tt ) <br /> Quantity installed i �— 4 Discussed with geologist: - (y/n ) <br /> Type of method <br /> EH 29 29 <br />