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14TORING WELLgNSTT*j LATION ItEPOrLf k, _ <br /> D Z CONSTRUCTION <br /> Date: ,, w . <br /> 4 <br /> Premise Address: /fid �� - -Total Depth <br /> Screen Length {from) D (to) <br /> ti 0 _.� / l/9 to <br /> Well No.: Filter Pack' (from)`- (to) <br /> y .Bentonite it (from} k to) <br /> .� Ins ector ' ^ kms *. _ `�,,, ti Grout Nwf(from} " �; 'Ato) <br /> P -,~ - -*,�,Drilling rig-type <br /> Permit No. <br /> Auger O.D�: I.D. a _ <br /> Completion - Stove pipe/christieNbo'k (circle one) <br /> \.Drilling Company: <br /> 1 ' i casings <br /> Driller: f i height. , <br /> VA <br /> e Consultant _ <br /> �w � 4 <br /> + `<t Geologist ` ABOVE-GROUND. v <br /> COMPLETCN <br /> "� .. SPECIAL PERMIT INFO. _ _ Y 4rour�c'aurisc� <br /> 'Distance-to sewer line a <br /> Domestic;well on site-,{Y <br /> If yes, location and distance - ,v ft• <br /> '-��.*t v�i' +w� �`�jam- ?7E,- .x. �` ~',` ,�-4+1i�.�r Y �1 ��y-:'.T'� F_^''l �� 13. �'m; ,: 1: •` � <br /> c� . .+ �+ J•r��,.y `+"jam,+•,� ,�- — x C� "�'" =-,.r-"G-:-•-�a..-•-..--..r- •{ <br /> SAMPLING "+° . slottad <br /> W ion <br /> f Holding Tempera ' -. �,0e.j Pack <br /> Method x } <br /> 't Screening Method / " — <br /> '' TrackingSheet C Y <br /> .s"• <br /> at <br /> A. <br /> t SPOILS ' ;t • '•K . � � �•` " �,, 4, { - <br /> 'Storage'Method' a (�ia �� `�`�'�'�� �_MATERIALS EVELOPMENT y x <br /> i <br /> S Contamination Noted - (y n <br /> Storage Location '' Casing type <br /> ~ Blank " ft. Screen ft. <br /> $lot size I <br /> j GROUTING Bags eerrent' ' / <br /> Buckets bentonite O z ( <br /> I f <br /> .',Dept to:water Bags sand/gravel �. <br /> Mix Ratios r Filter Packtype/size <br /> Installation Method / Ots Surge Block: - (y n j a <br /> Quantity Installed, � �.' r v Discussed with geologi t: n) <br /> y Tyre of method <br /> EH 29 29 <br /> IN <br /> 14, <br />