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i <br /> _JNITOFUNG WELL INST TION REPO'. <br /> Date: O • •r4 Z•' CONSTRUCTION <br /> Premise Address: L Total, Depth -3 <br /> Screen Length (from) 3 (to) <br /> Well No.: 1`'(� ' "1 Filter Pack (from) 3 (to) <br /> Bentonite (from) G (to) <br /> Inspector: SC�7�clf� Grout (from)_ 44 (to) <br /> Drilling rig type <br /> i <br /> Permit No. 92 Auger O.D. /.P.v6' I. ., <br /> Completion - Stove pip e o (circle one) <br /> Drilling Company: w t'17 <br /> Driller- 'nw casing <br /> T height <br /> Consultant <br /> Geologist <br /> Ali; E-GRCVND CNFi1.STY-BOX <br /> OOMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Card SWUM <br /> Distance to sewer line } 'rb. prat <br /> Domestic well on site - (y/CQ �_.ft. <br /> If yes, location and distance - fL <br /> ft. <br /> R <br /> SAMPLING =lanai <br /> sacycn <br /> Holding Temperature �C " - V+ Pa <br /> Method /.Cc „T _ <br /> -Screening Method / <br /> Tracking Sheet - ( n ) <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y433 <br /> n <br /> Storage Location S1 �' Casing type <br /> Blank. 4$ ft. Screen ft. <br /> Slot size o•�Z <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios,_ _ Filter Pack type/size 3 <br /> Installation Method 1 tv Surge Block: . fes/ n ) <br /> Quantity Thstalled Discussed with geologist: n ) <br /> Type of method,_ 2 <br /> EH 29 29 <br />