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'� '.fi QTORING WELL INSTALLATION REPOtCte-' <br /> Date: <br /> /Z I Z CONSTRUCTION <br /> ,�j�� �✓ <br /> Premise Address: "'�`� / �Q�'� �y, e'�!/��G�( Total Depth % Q09 <br /> Screen Length (from) (to) 45 U <br /> Well No.: Filter Pack (from) :242 (to) S O <br /> Bentonite (from) Z (to) 3 4, <br /> Inspector: _ y`-� Grout (from) g , (to)—3!Z. <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. (o <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant !�140 • <br /> Geologist Agpyg-GROUND <br /> COMPLETION JSTY-80 <br /> C ON <br /> SPECIAL PERMIT INFO. Ground Suriacs <br /> pout <br /> Distance to sewer line <br /> Domestic well on site - (y 4!D ft. <br /> If yes, location and distance - 3� 1 ?4 ft.ft. <br /> ' m <br /> = r <br /> SAMPLING slotted = <br /> . — <br /> secton <br /> Holding Temperature _e4av <br /> _ SSiay"Pack <br /> Method =_ <br /> Screening Method c = <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method �'�* ' MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y,7 n ) <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> .Slot size .0 O <br /> GROUTING Bags cement <br /> Buckets bentonit 114af <br /> Depth to water Bags sand/gravel <br /> Mix Rados_ 19' rt4. Filter Pack type/size 12- <br /> Installation Method Surge Block: (}► n -I. <br /> Quantity Installed - Discussed with geologist: - ( <br /> Type of method <br /> EH 29 29 <br /> 2" <br />