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MO' `'glNG WE..•LL INSTALLATION REPORT <br /> Date: �3 CONSTRUCTION <br /> IQ�1 <br /> P-e:rise Address: �Z7� ^� y �'`�" ToW Depth '4to Screen <br /> Length (from) 9 C ) Z <br /> Well No.: 2 s Filter Pack (from) Z� (t) Zct S <br /> Bentonite (from) <br /> Inspec:or. <br /> Grout (Eros) 24 ,5 (to) �- <br /> Drilling rig type <br /> Permit No. 3-blZ(o Auger O.D. I.D z <br /> Completion- Stove pipe/chrstie box (circle one) <br /> Drilling Company. <br /> � In ing <br /> Dr1ler. T�f' f _ I <br /> � height <br /> casIV <br /> ConsultantA" L /Z -W\ 0-Ti <br /> "J, &DL' � <br /> G20IOg1sL C�'(�1�-a'X <br /> CrtvP�.r�iCN C:MP!._=nCN <br /> Ground Sutsca <br /> SPEC! PERWT INFO. <br /> ptovt <br /> Distance to sewe_*line <br /> ft' <br /> Domestic well on site - ( y/ n) <br /> IE yes, location and distance - <br /> �z <br /> ^A 3 <br /> �+ O <br /> LL���� 0 <br /> SAIMPLING ILA a w,�N sbctad _ a <br /> scion x�: <br /> Holding Temperature = gm;9I Pack <br /> Method <br /> Sc:eening Method = <br /> Trackdrig Sheet - (y n) <br /> SPO[LS <br /> Storage Method MA717c UALS/DEVELOPNLNP <br /> Contamination Noted J (y/ n ��C it <br /> Storage Location (� dl Casing type <br /> Blank Z°I fL Screen ?4a Et. <br /> Slot size .Oti <br /> GROU"iNG Bags cement <br /> Buckets bentonite 4 <br /> Depth Co water Bags sand/gravel <br /> Mix Rados Filter Pack type/size AF5 <br /> lnstalladon Method Surge Block: - C& n) <br /> Quantity Installed Discussed with geol 'st: - (y/ n) <br /> Type of method <br /> �5 �GUZC� .1aV 3 6) <br />