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MrORING WELL INSTALLATION REPOnf4 <br /> CONSTRUCTION <br /> Date: � r <br /> U Total Depth <br /> Premise Addr ss: Screen Length (from) O to) <br /> 9�P Filter Pack (from) 410 (to) !�S _ <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector: Drilling rig type G^`'� <br /> &Ve52a-3 Auger O.D. S' I.D. <br /> Permit No. stie box (circle one) <br /> Drilling Company: tfa �° Completion - Stove pipe/chri <br /> t� casing <br /> Driller: Q. / height <br /> Consultant ��� T <br /> Geologist AE&E-GROUND CHSLM.gox <br /> COMpLETION COMPLETICN <br /> G=nMd Surra. <br /> SPECIAL PERMIT INFO. <br /> proof <br /> Distance to sewer linec � 6 sg ft. <br /> Domestic well on site - (yon <br /> If yes, location and distance - ft. <br /> Zft. <br /> 14. <br /> y 9106dSAMPLING 4 a4doc <br /> gmI packHolding Tempejature <br /> Method <br /> Screening �Method <br /> Tracking Sheet - <br /> SPOILS <br /> 55 t S MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Note - ( �� t}� �t �_ T E Casing type_ 'J <br /> Storage Location f ('�`"r Blank $O ft. Screen Za ft <br /> Slot size <br /> n20" <br /> Bags cement <br /> GROUTING Buckets bentonite LLW M" <br /> Bags sand/gr <br /> avel 8 <br /> Depth to water 1 ado Filter Pack type/size 3 <br /> Mix Ratios Surge Block: - (y n <br /> Installation Method Discussed with geo ogist: - (YA no <br /> Quantity Installed //0 Ca/ Type of method <br /> EH 29 29 <br />