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MO#RING WELL rNSTALLA;ION R:oORT • <br /> Date: 'L Z`I-( ((3 CONSTRUCTION <br /> Iv <br /> Precose Address:_ � � �� � Total Depth 6g•J <br /> Screen Length (from) 67 (to) <br /> Well No.: /u/U� Filter Pack (from) 70 <br /> (to) 3 <br /> Bentonite (from) 3 (to) 41 <br /> Inspector: Grout (from) (to) o <br /> Drilling rig type C/j1E 95 <br /> Per .ic No. ��/ DOJ Auger O.D. /z z" I.D. 7'f! <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company-. <br /> Driller. height <br /> Corsul:anr Gil/DVX//��2 <br /> Geologist V""�'r'� �G/�iiG(,Gjc� A30VEGAC(ND " ! <br /> Cr'MP�_i 1CN CNA -3CX <br /> CMP�L ii ICN <br /> SPECIAL PER-WT INFO. GrvundSuixa r <br /> C� <br /> Distance to sewer line ,/ prat <br /> Domestic well on site - ( y/ n) <br /> If yes, location and distance - Q ^Q B — {t. <br /> — m <br /> — e <br /> �I. <br /> SA-,'vIPLiNG 4 do«ad _ c <br /> x a I <br /> radon ' <br /> Hold ng TempeSature I e �k,` - Bawl adc <br /> Me hod_ C�C sObs� <br /> Screening Method IVNa z _ <br /> Trac'.ang Sheet - ( ( n <br /> 3 ) / n ft <br /> �v Gb�$ ft. <br /> SPOILS 70 3� d <br /> Scorage Method_ .-e MAT'cRIALS/DEVELOPNLNT <br /> Concam nation Noted - e/ n )-Storage Location 7Syt Casing type y �Q /01(L <br /> Blank 48 Jr- Screen ZO fL <br /> Sloc size O7tD <br /> GROUTING C� y`Z5f 9.3) Bags cement 0 <br /> Buckets bentonite 2 <br /> Depth to water $6 Bags sand/gravel 13r2-_ l5 <br /> Mix Rados_. , , Facer Pack type/size +� <br /> Installation Method_"� �I <br /> A `i'LNc 45A Surge 31ock: - (y <br /> Quancicy Installed Discussed with geologist: - (© n ) <br /> Tvpe of method <br />