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E 1 1V O—RING WELL INSTAUAT10N REF` r <br /> V _ <br /> Date: 'i �' "q(, CONSTRUCTION <br /> Premise Address: 7-1(71 aac'tk Lti1 Total Depth <br /> Screen Length (from) 2 (to) <br /> Well No.: AAS Filter Pack (from) Z'"i (to) � <br /> Bentonite• (from) 4 (to) <br /> Inspect'r: Grout (from) (to)- <br /> Drilling rig type <br /> Permit No. Auger O.D. <br /> �. Completion- Stove pip a cir one) <br /> Drilling Company: �J��T�� , n11N(, <br /> Driller:�l ����� casing <br /> n� height <br /> Consultant l��—T-P, �' <br /> V rm <br /> � � <br /> Geologist L�t LL `JPt1� <br /> ABOVEI9RCUND CHR1SiY BOX <br /> COWLETION LETIO <br /> SPECI IAL PERMIT INFO. Ground Stafaes T�� <br /> Distance to sewer linan <br /> e grout <br /> Domestic well on site - 'Y/( <br /> y/ 3 n, <br /> If es, location and distance <br /> 1 <br /> y F <br /> i � C <br /> o <br /> SAMPLING slotted v,.' __ B <br /> ssc9an ;r <br /> Holding Temperature gra„iW pack <br /> Method <br /> Screening Method _ <br /> Tracking Sheet / n) <br /> F Z'-) n. <br /> SPOILS <br /> Storage Method OkfnA it:, — 1�11D�1Z�I�It�112 Lkld pl&'�C-" MATERIALS/DEVELOPMENT <br /> Contamination Noted -�V n ) �y I `J�hE �I D\ <br /> Storage Location�K1 Casing type �1 I <br /> Blank .c�, ft. Screen !V ft. <br /> Slot size ` <br /> GROUTING Bags cement h ul W'R . <br /> Buckets bentonite t - <br /> Depth to water Bags sand/gravel --�� <br /> Mix Ratios 1 Filter Pack type/ste =— <br /> f <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geolo 'st: -�/ n) <br /> ¢ Type of method <br /> EH 29129 ' <br /> Ta ISIS <br /> bAGVAOVnvh <br />- -9- 4._199 <br />