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MO"..,ORlNG WELL INSTALLATION REPORT <br /> Date: I — 13 '-q Ll 3 CONSTRUCTION Well No.: I/l7 <br /> 4 p V <br /> Premise Address• Jr-OCA �OS 2]� Total Depth <br /> Screen Length (from) 1!? (co) <br /> Well No.: YVllln I nil, ( � 10 3 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. l [� Grout (from)�(to) [7 <br /> , Drilling rig type <br /> Permit No.- 01 1 `c7o (-7 Auger O.D. <br /> Completion - Stove pip Christie bo (circle one) <br /> Drilling Company: �Ulm <br /> Driller. 44 4 CONSTRUCTION Well No.: �-- <br /> Consultant I�1 VIC 1LN%� Total Depth <br /> ��X Screen Length (fro;Q Q,Z—(to) Z(� <br /> (r Filter Pack (from) SCS (to) 2 <br /> Geologist 11Jvl� 1 �_ 5�7 <br /> Bentonite (from) (to) 2 <br /> Grout (from)_ =to) 0 <br /> SPECIAL PERMIT INFO. Drilling rig type <br /> Auger O.D. <br /> Distance to sewer line Completion - Stove pipe/ mtie box (circle one) <br /> �. <br /> Domestic well on site - (y/ n) <br /> if yes, location and distance - <br /> CONSTRUCTION Well No.: MjV e <br /> Total Depth b/ <br /> Screen Length Cfrom) <br /> Filter Pack (from) (co) <br /> SAMPLING Bentonite (from) '� ( J --- <br /> -4 <br /> Grout (from) 'L (to) <br /> Holding Temperature Drilling rig type <br /> Method Auger O.D. D <br /> Screening Method Completion - Stove pipe/ ' tie box ( cle on!) <br /> Tracking Sheet - (y/ a) <br /> SPOILS rI ', <br /> Storage Method �� G Q 00TH P'W(LL MATERIAIS/DEVELOPMENT <br /> Contamination Noted - / n) u <br /> Storage Location Slag�� � Screen M <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bcntonice <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size /Z <br /> Installation Method Surge Block: - ( y/0 <br /> Quantity Installed Discussed with geologist: - ( y/ n) <br /> Type of method <br /> EH 29 29 <br />