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MOORING WELL.INSTALLATION REPORT <br /> _ Z CONSTRUCTION z,56 <br /> Date: <br /> Total Depth �Z•5 Ti <br /> Premise Address: 5 0 ( (to) 5/ <br /> Screen Pack (from)(from) ( (to) <br /> Filter Pack (from) <br /> Well No.: Z/`ir�v s � Bentonite (hom) (to) <br /> Grout (from)—�-5 (to) <br /> Inspector: Drilling rig type o / <br /> Auger O.D. 9j 4� t n 4 <br /> Permit No. chrisd <br /> �y�,��/ A' Completion - Stove pipe/ tie box (circle one) <br /> Drilling Company: !.f/'�/x ^/ <br /> -� casing <br /> Driller•. ,�J� �� T height <br /> Consultant <br /> Geologist A90VE�aiiWND <br /> CttP�sl/BoX <br /> cowLEETCN OMP <br /> svrx, .� 9 <br /> SPECIAL PERMIT INFO. grout <br /> Distance to sewer lute �d n <br /> Domestic well on site - ( n <br /> If yes, location and distance - <br /> o <br /> tiottad wr <br /> SAMPLING <br /> sachon A' <br /> - pravel,,ack <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - ©' n <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contaminadon Note- y Casing type a� _TJ pile, <br /> Storage Location Blarilc 5 I fc Screener_ <br /> Slot size 02 <br /> GROUTING Bags cement r --- <br /> Buckets bentonite <br /> Depth to water�`�i-3 �*� Bags sand/gnvel <br /> Filter Pack type <br /> Mix Rados / e <br /> si? <br /> Installation Method Surge Block: - / n ) <br /> Quantity Installed Discussed with geologt t: ©/ n ) <br /> Ty <br /> pe of method <br />