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CORING WELL INSTALLATION REPOIO <br /> Date:— S �- � //9 <br /> �yy �j CONSTRUCTION <br /> Premise Address: G'�D IPO Total Depth 0 <br /> Well No,: - (/ Screen Length (from) (to) <br /> Filter Pack (from) 1aQ (to) <br /> Inspector. Bentonite (from) (to)! <br /> . Grout (fro o) <br /> Permit No. i-S 2.- Drilling rig type (L <br /> qq Auger O.D. I.D. ' <br /> Drilling Company: QCompletion - Stove Pipe/cluistie box (circle one) <br /> Driller: <br /> casing <br /> Consultant ES � 7\height <br /> Geologist�� <br /> A80VE-GACUNO / <br /> COA unoN CNRSTY-a0X <br /> SPECIAL PERMIT INFO. Ground BCCMPLEnCN <br /> urton <br /> Distance to sewer line <br /> Domestic well on site 4(yl n) proof <br /> If yes, location and distance - ft, <br /> m <br /> SAMPLING 7J <br /> ' 5lor:nd J c <br /> Holding Te perature sonon <br /> Method 1✓i�1✓ _ �� <br /> Screeningv4vtetnod Z7 _ <br /> Yp <br /> Tracking Sheet - (y/ n ) <br /> . tt' <br /> SPft. <br /> OILS n <br /> Storage Method_ �' ! _ �� (>wY� r,11 MATERIALS/DEVELOPMENT <br /> Contamination Note¢- ,-y ) <br /> Storage Location_ > /IL,�-^i <br /> Casing type <br /> Blank I fr. Screen fr, <br /> GROUTING Slot size2-9Bags cement 2 <br /> Depth to water Buckets Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method , t Filter Pack type/s ze_ _2 <br /> Quantity Installed Surge Block: - R/ tt`f <br /> Discussed with geologist: - 01 n) <br /> EH 29 29 Type of method <br />