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ON:REPORT „ w� <br /> 1,A0N1V)?ING WELL iNS SALLA'PI <br /> x <br /> CONSTRUCTION- <br /> Date: <br /> ONSTRUCTION Date: cZ . <br /> ��� Total Depth <br /> Premise Address: - _ ` » <br /> Screen Length (from)-. � . (to) <br /> Well No. Y Filtet Pack (from) (to)j <br /> Bentonite.' (from) (to) <br /> Inspector Grout (from) (to) <br /> Drilling rig type <br /> Pe tt'No. w Auger O.D. T.D. <br /> Completion.- Stove pipe/christie box (circle one). <br /> t Drilling Company: <br /> f. , Driller: casing <br /> _ height <br /> r � Consultant rt ` <br /> S Geologist - k <br /> AWYE-GROUND. CNRISTY-BOX, <br /> - COWLEVON COMPLETION <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line - „ _ �_4r : •, _ <br /> Domestic well on site - (y/n] <br /> # if yes, location and distance - x - <br /> ft. <br /> SAMPLING <br /> on <br /> Holding Temperature°{'� ✓ v„ _ gn� <br /> Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/nIF <br /> ) — <br /> _- <br /> SPOILS <br /> 4i Storage Method y - w MATERIALS/DEVELOPMENT ,p` <br /> � <br /> Contamination Noted - (y/ n ] <br /> II Storage LocationCasing type <br /> ! ... w Blank ft. Screen <br /> Slot size <br /> GROLMNG Bags cement <br /> Buckets bentonite <br /> ;Depth to water ✓ 2- Bags sand/gravel <br /> €Mix Ratios 4d;ett � ' _ -- _T Filter Pack type/size <br /> 'Installation Method Surge Block: - (y/ n ] , <br /> I aQuantity InstalledDiscussed with geologist: - {y/ n] <br /> Type of method <br /> LEH 29 29 <br />