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C�TOPJNG WELL INSTALLATION RE!'o�R . _ <br /> 4 <br /> /L7; ,2 7 CONSTRUCTION <br /> Date• <br /> s S-2> <3 Total Depth C ' <br /> Premise Address: . .. Screen Length (from) ! 3.7, S'__(to)_ iz'7, 67 <br /> '" <br /> s ' , Filter Pack (from)_ 13 8 ` (to) 125-,5' t <br /> Well No.: Bentonite - (front}� 125 S" ` __(to)� Z?-, r..� ' <br /> V c : Grout (from) 1 2Z-.S -(to)_ Sur e� <br /> Inspector. < . <br /> - Drilling rig a "So i C { <br /> Permit-No. X0.2 A�ge6 �. inC C s. I.D: <br /> F Completion - Stove pipe/ tristie o '(circle one), <br /> t Drilling Company: <br /> # casing <br /> Drill r: r �re <br /> Seol-fa�U4'4' �► - hei-qht <br /> ,� <br /> Consultant � 'r <br /> Con _ . <br /> - <br /> ABOVE-GFICUNR -80 <br /> CD <br /> kFLETION <br /> C0MPLE710N , <br /> SPECIAL PERMIT INFO.' -C3round Surtscf <br /> . Distance to server line U Z ��r &�3 <br /> B Domestic well on site - ((Fr n ) /5 5,4- x ft. <br /> i If yes, location and distance - a� 1,4ry1 P , Jzi5 ft- <br /> M 3D' �d „aft — u <br /> - Af6tIDA52'7 73u' <br /> I SAMPLING ,. __,�.. -,.. ,�A.- <br /> k 781 i2.3 tac7cn _ "ti " <br /> f i Holding Temperature ' ►Jof I o C%5� g l`-r`18 &�. _ gr,vit Pack <br /> G <br /> Method cJ � <br /> Screening, Method I go+ 18`I 18` -lza` :"L _ <br /> Tracking Sheet y n ) ;�� 5 <br /> F <br /> mi <br /> ISG . 4. <br /> SPOILS <br /> . . r..3 Z'. r, $ t i <br /> ` JJ - <br /> Storage Method ` S r <br /> , ,8, G�r v x+25 1-38 '- S$MATERIAIS EVEI,OPMENT _ <br /> I Contamination Noted - n ) ' <br /> Storage Location rtP� w. Casing-type .'4- SG �0 <br /> Blank 1�'7;S . -Screen <br /> kftft. <br /> .-SIot size 7,0.2,01 <br /> GROUTING - H7 4� �Yi b �tGJ C J,+ry e i's� Ba cement <br /> g �-3o aUt�..1nN�,o 3. re scene' bentonite - lis �, <br /> ' KK..50-ib� <br /> 1 Depth to water S s. Bags sand/gra. 5 b <br /> Mix Ratios o Ib �7-lb Filter Pack type/size 41- 3 U <br /> + / ' b Sure Block:.- (y tt <br /> Installation Method r g <br /> Quantity Installed Discussed with geologist: - I n). , <br /> Type of metltod IV <br /> Lr1 o r lc l�rr. � '' - eEH 29 29 <br /> +�►�; �7 a�. � I�o2� <br /> r 16 l ers <br />