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MOJORING WELL INSTAL—T XTION R°ORT • <br /> s /f <br /> Dace: S /943 _ CONSTRUCTION <br /> P //7 �2 <br /> P7,'-;se Address: l/�OU S . _ 5��Depth <br /> ngLh (from) l l (to) l 0'4- <br /> Well No.: C'Z - Filter Pack (from) !!/— (to)� <br /> Bentoni[e (from) 99 (to) 9 5 <br /> Inspector. �- Grout (fro ��_([o) <br /> Drilling rig type ft� <br /> Pe.—.;.: Vo. 9✓ 'I7�y Z Auger O.D. I D. <br /> f Q Completion . Stove pipe/chrsde box (circle one) <br /> Dr11L-g Company: <br /> ca 4 ng <br /> Diller. Q 0 �� T heig t <br /> Corsuttan <br /> Geologist �ED ABCvI:3RCUND C7�+r--S•. f-3= <br /> fR-CN CCMPI-=TICN <br /> rd S xa �- <br /> S?crlar PERMIT INFO. <br /> prat <br /> � r <br /> Dista^.ce to sewer line /✓�� ft. 5 <br /> Domestic well on site - ( y/ n) �tL <br /> If,yes, location and distance - 7tt. <br /> 3 <br /> - o - p <br /> C <br /> m <br /> gp�rot iNG uc on ' <br /> IyidL-tg T lSl� (�•cJt-�� �-�0 �' 3 -� 7i `^ = Ga�w <br /> pack <br /> Me--hod — <br /> Sc:!ening Method <br /> Tracking Sheet - C y/ n ) <br /> L/ �� <br /> SPOILS 1�0 <br /> ' MA i cRIALS/DEVELOPIvENT <br /> Storage 'vIe:l:od .A�— � <br /> Contamination Noted • ( y/ n ) Casing type q,' � � ?Je <br /> Scora,e Location 0", A Blank1 Io5---ft Screen l5 <br /> Slot size <br /> Bags cement ✓e <br /> GROU? NG Buckets bentonite <br /> Depch co water <br /> Bags sand/gravel <br /> Mix Ratios 3 '` +40 * I '��� = 1�� Filter Patti rypelsize <br /> "a Q Surge Block. - ryn) <br /> Ins:all aron Metho Fd 5 `per Discussed with eologist: - y n ) <br /> Quand y Installed - Type of method IC I p <br />