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OTORING WELL INSTAUATION REPO.; <br /> i <br /> Date: • 13 - 92 CONSTRUCTION <br /> Premise Address:. 055 L Total Depth <br /> Screen Length (from) 3/ (to) re <br /> Well No.: . V ts� — �'1 S Filter Pack (from) 9/'S' (to) -C ; <br /> Bentonite (from) 5 (to) <br /> Inspector: • Sea�� ---- Grout (from) 3.5 [io) <br /> Drilling rig type <br /> Permit No. Z 2, Auger O.D. b.z� <br /> Completion - Stove pip cl stie box circle one) <br /> Drilling Company: <br /> Driller: eA casing <br /> height <br /> IT <br /> Consultant -�-° <br /> _ T <br /> Geologist AiO�-GRCUNO <br /> COMPLETION CiiFif.M43OX <br /> COMPLEMN <br /> SPECIAL PERMIT INFO. Ground Suds <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft- <br /> s� <br /> a <br /> SAMPLING slot: w <br /> ascicn _ <br /> Holding Temperature_ �`G. _ _ ¢,,,IW PaCk <br /> Method poo Le_X— <br /> Screening Method =_ <br /> Tracking Shcet �' n ) _ <br /> IF <br /> SPOILS <br /> Storage Method d C..._ , MATERIALS/DEVELOPMENT <br /> Contamination Noted - ZY n ) Q5 (2t4!1 y <br /> Storage Location 6 Casing type 4 SU4 'fo �L- <br /> Blank ft. 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 &OW-W_.: <br /> Installation Method �5 <br /> ,' QW Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) > IJ pr <br /> Type of method <br /> EH 29 29 <br />