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OMTORING WELL INSTALLATION REPOO <br /> Date: '2 CONSTRUCTION <br /> Premise Address: 4,0 S L Q yp/, Total Depth_ <br /> Screen Length (from) 2d) (to) <br /> Well No,: IVlW "2k - ld r B}-4 W017ov(-Filter Pack (from) (to) <br /> llr! i izspleisrBentonite (from) (to) <br /> Inspector. - _I�l' hJ2: m� e�_ Grout (from) (to) Jar 9E . <br /> �i Drilling rig type <br /> Permit No._ 71 4,-9 � / g Auger O.D. A I.D. Z <br /> Completion - Stove pipe/christie b Tircle one <br /> Drilling Company- <br /> Driller: <br /> ompany T <br /> Driller: s: ��Qo //pry' r i�,1�cJY casing <br /> — '�-- �� height <br /> Consultant�Lnp h mss,"c c �Yil/i fclnrn��tf `4 <br /> `l �4Sx•ess rn e its tr,�. <br /> Geologist_ _ ff4x ABOVE•GACUND <br /> OOWLEi10N SPECIAL PERMLT INFO. <br /> Groutd Sulam <br /> Distance to sewer liner rhe grout <br /> Domestic well on site - (y/ d <br /> If yes, location and distance - ft. <br /> ft ft. <br /> 30 v SQ ,/f G1 �e a�eif S� i12/�f✓R� , <br /> SAMPIdNG <br /> socicn = <br /> Holding Temperature ee_ ` <br /> Method I` 1 r /�� .n; _ gavel pad, <br /> Screening Method _ .. <br /> Tracking Sheet <br /> ft. <br /> SPOILS <br /> Storage Method- <br /> Contamination <br /> MATERIALS/DEVELOPMENTContamination Noted • (y,p) / <br /> Storage Location_ o n S;fie- Casing type <br /> Blank S ft. Screen i t-- ft. <br /> Slot size <br /> GROUTING Bags cement x Plr4 n <br /> Depth to water Buckets bentonite c - S- <br /> P Bags sand/gravel 2 Jam^ <br /> Mix Ratios - # I [ — Filter Pack typesize z 2 L <br /> Installation Method Surge Block: - ( y/ <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 Type of method <br />