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JTORING WELL INSTALLATION REPORTO <br /> Date: O �! !2 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: � l 3 Filter Pack (from)_(W) <br /> Bentonite (from) (to) <br /> Inspector: Gia Grout (from) (to) <br /> p Drilling rig type (3- <br /> oZ 0 3 S a— Auger O.D. 7 I.D. 1 <br /> Completion - Stove pipe/rhrstie box (circle one) <br /> Drilling Company: <br /> ,Q� p , casing <br /> Driller. /�"v-""1 _[y/ �- � height <br /> Consultant <br /> /' /lytip ,r/ .Ld•�IJ'L ABOVE-GROUND . <br /> Geologist <br /> Z C WFC`,CN CCMPI.=i!CN <br /> G=rd Sutxe <br /> SPEC:AL PERMIT INFO. <br /> prom <br /> Distance to sewer line �� ��""`f <br /> Domes-dc well on site - ( y/Q) fL <br /> If yes, location and distance - �g <br /> — m <br /> 73 <br /> clotted C <br /> SA.M?LING socdon <br /> vive,rack <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet • ( / n ) <br /> SPOILS <br /> Storage Method '15- MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n <br /> Storage Location !�( Casing type a ckP✓C <br /> Blank fr. Screen ZO ft. <br /> Slot size <br /> GROT,RG Bags cement /Z <br /> � a <br /> Buckets bentonite <br /> Depth to water d ,/ � Bags sand/geave-i_ <br /> Mix Ratios / 9�f" ADM /� Filter Pack type/size <br /> Installacon Method rw3 Sly ,q Surge Block: - (0 n ) <br /> Quantity Installed _ f���'']I Discussed with geo ogisr - (©/ n ) <br /> 0000 Tv <br /> pe of method <br /> V" <br />