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MO RING WELL INSTALLATION REPORT • <br /> Date: CONN alb 11�1r <br /> �p o c, 72.5 sr <br /> Total Depth , <br /> Premise Address: Screen Length (from) (to) So <br /> Filter Pack (from) <br /> 9 .5 (to) b. <br /> Well No.: Bentonite (from) 5 (to) <br /> C4. Grout (from) 8 (to) <br /> Inspector: Drilling rig type 75 <br /> i� Auger O.D. ID. <br /> Permit No. Completion- Stave pipe/chnstie box (circle one) <br /> Drilling Company. <br /> casing <br /> £ ��T height <br /> Driller. <br /> Consultant <br /> Geologist N/ L ABOVE-GRCUNO CHMM-BOX <br /> CCMPL_ErCN CCMPL–TION <br /> Ground Sumacs <br /> SPECIAL PERMIT INFO. =/Owl // grout <br /> Distance to sewer line <br /> 750 �uvry 1,46 ,_n. <br /> Domestic well on site . n n) �r/� — f <br /> if yesw location and distance <br /> - <br /> siottsd � = a <br /> ssc on x; <br /> SAMPLING <br /> Holding Temperature <br /> r O�7`�l:C ` �r'+vel raCC <br /> Method <br /> Screening Method _ <br /> Tracking Sheet • ( n ) — tt' <br /> SPOILS <br /> Storage Method SS MATERIA/DEVELOPMENT <br /> Contamination Noted - y n) � '` 7d Yc _ <br /> Casing type <br /> Storage Location 8V. Blank ft Screen Z h• <br /> Slot size Q <br /> Bags cement 2– <br /> GROUTING <br /> GROUTING Buckets bentonite <br /> J J Bags sand/gravel r C <br /> Dept to water Oz / "�� " Filter Pack type�/ ize <br /> Mix Ratios Surge Block: - C e n ) <br /> Installation Method 6"N- Rg4a-Z — Discussed with geologist: -(6V n ) <br /> Quantity Installed_ Type of method l.01�� <br /> 92' <br />