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�t TORING WELL INSTALLATION REPO,--.,-' <br /> Date: 1!� CONSTRUCTION <br /> Premise Address: Total Depth <br /> Scree Length (from) (to) <br /> Well No.99411Js Filter P ck (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casfng <br /> height <br /> Consultant fl61 <br /> Geologist .. <br /> ASOVE-GRCUND CHRM Y-BOX <br /> � OQ[�L.ETlON COMPtrtTfCN <br /> SPECIAL PERMIT INFO. ��%(1. � Ciroc�rod S+.a�fxs <br /> Distance to sewer line ofDut <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - it. <br /> fl. ft. <br /> SAMPLING <br /> s*cicn — <br /> Holding Temperature <br /> Method ' _ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> a._...�.....tt. ._.......Ft — tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <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 29 <br />