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UoONIT01UNG WELL INSTALtAMON REPOR J <br /> Date:_ f { COtiSTRUC ION <br /> Premise Address 3 -2- Total.Depth <br /> Screen Length (from) (to) <br /> Well I>I©.: '' Filter Pack (from) (to) <br /> Bentonite (from) <br /> Inspector: - "`r ' '` Grout (fro ) (to} <br /> Drilling rig e <br /> Permit Na. Auger O.D. ----- I.D. - <br /> Completton Stove gige/christie box (circl+ one) <br /> Drdler; casing <br /> he'xghts <br /> Consultant .-�,_a <br /> Geologist ���-� :« <br /> J4Bt3Y'l~•GAG'MQ �MY-B�lX • <br /> C:QWLETON <br /> COMPLEMN. <br /> SPECIAL PENT INFO'S,. Ckvund 5otacs . <br /> Distance to s WO liiae a . <br /> Domestic well on site -(y. n'- <br /> If yes,location and-distance <br /> ft. <br /> �A. <br /> R <br /> Y � <br /> s, O' <br /> SAMPLING 1:q 524uBotta.•! ;? „��„ � <br /> . jit, i4C�Icft : <br /> Holding empera t <br /> Method ttlwj <br /> r +'t°� <br /> .r ....: <br /> Screening Method <br /> w <br /> Tracking Sheet - y " n } � � <br /> SPOILS <br /> " <br /> Storage Method _MATERIALS/DEttEIOPMENT <br /> Contamination Noted- (y I n <br /> Storage Location�j 2 C oil Cash � L-1 <br /> Blank ft. Screen a-0 ft <br /> Slot size AL2 <br /> GROUTING Bags cement 10 <br /> Buckets bentonite 0 <br /> 11 <br /> Depth to water Bags sand/gravel 3ltlo <br /> Mix Ratios i <br /> FilterPack type/size 3 <br /> Installation Method-: g=4 Surge Block: - (y } <br /> Quantity Installedd ' Discussed with geo gist: . Cy n) <br /> —. Type of method' <br /> H 29 29 <br /> lv&61-:5" xt <br />