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MOORING WELL INSTALLATION REPORT r <br /> r r <br /> Date: CONSTRUCTION <br /> _ r r <br /> Premise Address: e�`y''� h L Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> /� Bentonite (from) (to) <br /> Inspector: I\kk'14A"_ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluisde box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> - 'F he_gttC <br /> Consultant <br /> Geologist ABOVE-GFICUNA <br /> COWLETICN CMCVUSL TPLTiC ICK� <br /> SPECIAL PERMIT INFO. G=nd Sufact <br /> Distance to sewer line �f <br /> Domestic well on site - (y/n) � <br /> If yes, location and distance - ft. <br /> ft. <br /> M <br /> SAMPLING slor.ai = c <br /> tacicn <br /> Holding Temperature- PM— <br /> Method f� <br /> Screening Method <br /> Tracking Sheet - {y/ n) a. : <br /> ft tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n) <br /> Storage Location Casing type <br /> Blank ft- Screen___.fl. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 2g. . <br />