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Mrs oRI.NG WELL INSTALLATION RPPO <br /> )hoe <br /> CC3NSTFtCTCITQN <br /> Date: <br /> y <br /> P:e mise Address: Total DepthScreen Length (from) (to) <br /> .� Filter Pack (from) <br /> Well No.: Bentonite (front)- <br /> Grout (from) <br /> Inspector: Drilling rig type ' <br /> . . <br /> Auger O.D. <br /> Permit NoI.l?. <br /> Completion - Stove giPe/chti.6m box (circle one) <br /> � ..... <br /> Drilling Ccmparty; casing <br /> l�rlter <br /> height <br /> Consultant <br /> ABOVE-GROUND <br /> Geologic Y tSiYCX <br /> CGMPt.::a 3G1'�t - <br /> Gndtxfaca _. ... .�.-*...� <br /> S? CiAL PERMIT t _NFO:. grout <br /> Distance to se*e..line <br /> Domesttc`well on sate - (y/n 3 .3 & <br /> If yes, location and dist4wo <br /> stood,w <br /> Holding temperature ._. <br /> Method. <br /> Scree,-ting Method ---- a: — <br /> Tracking Sheet -ryy n <br /> K <br /> SPiJII.S JJJJJ ��lljj'� jyytA fi <br /> OPNMNT <br /> :Storage Method <br /> Contamination Noted - (y,�,n:.: ,rt ► <br /> Storage Location Casing type <br /> Blank �ft Screen ! t� ft. <br /> Slot site •tD <br /> GR4U'I'ING Bags cement <br /> Buckets bentonite 8 <br /> Dept.'s to w ter )14 gags sand/gravel T �- <br /> Mix Ratio ` Filter Pack type/size * - <br /> Inscallacon McChod �.– Surge Block: - (y ab <br /> Quantity Installed Discussed with geologist: C An <br /> Type of method <br />