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__)NITOMNG WELL INSTALLATION REPOI <br /> Date: J un es Z1, 2o o 7 CONSTRUCTION <br /> Premise Address: 222 Mdn JTotal Depth Pe --fe'e.;t <br /> Screen Length (from) Z.0 (to) 70 <br /> Well No.: 42 Filter Pack (from) (to) (v ' <br /> Bentonite (from) lv8 ' (to) ;_ �-- <br /> Inspector. _ 'IV '4 r tom, Grout (from) .5� (to).-S L/'-fad- <br /> 15- Drilling rig type_ R l n e 4-Z <br /> Permit No. �7 0 Auger O.D. 8 i h I.D. 4, 2-S- <br /> Completion - Stove pipe/ tstie box (circle one) <br /> Drilling Company:�__'I-� r. 111% <br /> Driller:- 30 L�t�N �_)eQ Se casing <br /> f�.SII.s-F - Nick �Gke-ry an height 1 <br /> Consultant f�d��s nr�G� Lrt di reynrerl�r ��rSry� <br /> n '4 <br /> Geologist QGfS,L!1 JG+d C ' RGA -- <br /> Jj /1BO VE-GA CUND <br /> COkVLETCN tync <br /> -BOX <br /> SPECIAL PERMIT INFO. Ground Suriaco <br /> Distance to sewer line Uri YL D Le-ir, <br /> pram <br /> Domestic well on site - ( y/0 G S ft. <br /> If yes, location and distance - <br /> De� ft. <br /> — <br /> 3S 30p,0,n A <br /> • — r <br /> 0 <br /> SAMPLING SQ 70,�[ „ 1110a 10 _ <br /> ?9. txjcn <br /> Holding Temperature <br /> .2 , , <br /> G o S r- <br /> Method I e n i n ea I P+ G$' .Z7, 3 r _— <br /> Screening Method P 1 D 70 ' '36. z " <br /> Tracking Sheet - n ) 7S' 36 - _— <br /> Lj <br /> SPOILS <br /> Storage Method S"S- r -OW J f� MATE RIALS/DEVELOPMENT <br /> Contamination Noted - I rr <br /> Storage Location o-r�.c,ft Casing type 2 rut cSGY1GdJG 46 <br /> Blank 70 ft. Screen Z6 ft. <br /> Slot size . D Z D ;n <br /> GROUTING Bags cement )5' tD f-a.l b111As eor+iA7J� <br /> Buckets bentonite j YL 56- s <br /> Depth to water Bags sand/gravel S - ) ,s <br /> Mix Ratios g¢db_ laza Filter Pack type/size -t 3 <br /> Installation Method s Surge Block: - & n ) <br /> Quantity Installed B&IJ <br /> CB �Discussed with geologist: - 0 n ) <br /> Type of mctliod <br /> EH 19 29 uq�t 4U�{�'S <br />