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IOTORING V„rELL INSTALLATION REPOrn+ <br /> Date: 1��� / /�// CONSTRUCTION <br /> i <br /> Premise Address: Total Depth ,6 OV <br /> Screen Length (from) /OZ 6� (to) <br /> Well No.: L Filter Pack (from) 02' i" (to) <br /> Bentonite (from) " (to) (o n <br /> Inspector: Grout (from) 93'b' (to) O <br /> `� Drilling rig type <br /> Permit No. O� Auger O.D. !— I.D. <br /> J� Completion - Stove pipe/christie box (circle one) <br /> Drilling CoompanyQ: <br /> Driller: 'a— casing <br /> height <br /> Consultant 67W-$,4? <br /> Geologist /�S4TfI` /N�� 7cKUNG - <br /> ABOVEGROUND 7EnON <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surt <br /> ? <br /> Distance to sewer line <br /> Domestic well on site - (y 936' ft. <br /> If yes, location and distance - q� / ' ft. <br /> 7t <br /> N m <br /> SAMPLING slatted _ 8 <br /> sadon <br /> Holding Tempgrature 9�c grnrel Pack <br /> Method <br /> Screening Method <br /> r <br /> Tracking Sheet - n ) HOZ.6 rn <br /> h. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y / J,A / 1_ J 1J •r /yc <br /> Storage Location 'r S✓b` �hGf�•^►t Ji[[� ��*rS�' Casintype, ry <br /> Blank ft. Screen 5' ft. <br /> Slot size 0ZO <br /> GROUTING Bags cement <br /> Buckets bentonite I •9d <br /> Depth to water Bags sand/gravel 3 <br /> Mix Ratios b/✓ e Filter Pack type/size - <br /> installation M odSurge Block: - (y <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br /> �` i7- 3z <br />