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'1kNIT0PJNG WELL INSTALLATION REAM <br /> Date: CONSTRUCTION <br /> Premise Address: �l��_ (�1/. fS� 6� Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter pack (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: casing - <br /> r��� <br /> he, <br /> Consultant 1 <br /> —qVT <br /> Geologist <br /> ABOVE-GACOND CHAIM-BOX <br /> COMPLETION CCMPL-=nCN <br /> SPECIAL PERMIT INFO. Ground Swfwo <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING <br /> v. <br /> tocticn <br /> Holding Temperature .N <br /> Method — QMVIW FaCK <br /> Screening Method <br /> Tracking Sheet - (y/n ) - <br /> •.x <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank fL 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 />