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'--�ORING WELL INSTALLATION REPOlti,-.J <br /> Date: `� qs— <br /> CONSTRUCTION <br /> Premise Address: a'h^ <br /> Tota! Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Inspector: /� ^`' Bentonite (from) <br /> Grout (from) (to)�� <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/duistie box (circle one) <br /> Driller• <br /> ' � casing <br /> Consultant hes ght <br /> Geologist _ �► <br /> /1$OYE-GRCUND ` <br /> Gol 'S..°TION CHRZ Y-30X <br /> SPECIAL PERMIT INFO. Ground 5uriaas <br /> Distance to sewer Iineproof <br /> Domestic well an site - (y/ tt�j <br /> If yes, location and distandeft. <br /> v � m <br /> SAMPLING , <br /> to :ad c <br /> Holding Temp rature soc:cn <br /> Y <br /> Method ( I - c = MVIW we <br /> Screening?Method L16 <br /> Tracking Sheet / n — <br /> ...,.__fi. ft. <br /> SPOILS <br /> Storage Method MATEWALS(DEVELOPMENT <br /> Contamination Note n ) ���` �._. <br /> Storage Location rt� cJ er"ming type <br /> Blank ft Screen h. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to waterer 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 /> EH 29 29 Type of method <br />