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1+10' 7RLNG WELL INSTALL4 T ION REPORT <br /> Date: -�3 _ CONSTRUCTION <br /> Ntn�Vkai�- s Total <br /> ?:-em-se?:-em-se Address: �_ _� � Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to)�— <br /> Bentonite (from) (to) <br /> Insoec-.or. Grout (from) (to) <br /> 4 g Drilling rig type "3 <br /> Per-:rt No. 6 3 'I Z f <br /> .DAuger O . I.D. <br /> Completion - Stove pipe/chrstie box circle one) <br /> Delling Company: <br /> cas; g <br /> Driller: heig t <br /> Corsuitanr �" <br /> GeologistY=•uRM <br /> f N Ct�4RM I Y-3C X <br /> CCMP'1CN <br /> Ground Urfxs t <br /> SPEC!AL r PERMT INFO. <br /> groat <br /> Distarce to sewer line s <br /> fL <br /> Domesdc well on site - ( yl n) <br /> If yes, location and distance - �' <br /> 0 <br /> stoned <br /> SAMPLING <br /> Foldkla T emper a It-" <br /> Method <br /> Screening Method InIz7, <br /> Trac`,tiLr•ig Sheet y n ) <br /> SPOILS <br /> Storage Method >✓�`-P MA 1=-, iALS EVELOPIVLNT <br /> Contamination Noted - ( y n a'r <br /> Storage Location 'ply Casing type <br /> BlankTP ft. Screen /0 f <br /> Slot size 0 �- <br /> C-P.CL ING Bags cement <br /> Buckets bentonite <br /> Deoth to water Bags sand/gravel EY - <br /> Mie Ratios t6 C47O Filter Pack type/size -401L.S <br /> Installadon Method Surge Slack: - qy � n) <br /> Quant::y rnsralled ! Discussed with geolo est: - n ) <br /> Type or method .. �lU�"''''• <br />