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111TTORiNG WELL INSTALLATION REP <br /> OR,, <br /> ij <br /> Date: - I a2 CONSTRUgnON Well ENo.: <br /> Premise Address:_,i { 7 +L24 R-0 Total Depth l <br /> Screen Length (from) !, (to) 2 <br /> Well No co Filter Pack (from) 1j ` —(to) <br /> Bentonite (from) .1, (to)42 1 <br /> Inspector: L W_ Grout (from) '.' (to) <br /> Drilling rig type j <br /> Permit No. Auger O.D. !' I <br /> �S� Completion - Stove pipe/ tie bo ircle one) <br /> Drilling Company: { j " h <br /> Driller: YZ to I�i� -- CONSTRUCTION Well No.: . <br /> Consultant Ri;;Nr1 Total Depth <br /> II!! Screen Length (from) ,r (to) <br /> Geologist, dWl (� L,A � r"n Filter Pack (from) 1i (to) <br /> Bentonite (from) !' (to) -E] <br /> Grout (from) •a <br /> SPECIAL PERMIT INFO. Drilling rig type A <br /> Auger O.D. °1 <br /> Distance to sewer line Completion - Stove piphe/ zristie box circle one) <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - <br /> CONSTRUCTION Well No.: <br /> Total Depth <br /> Screen Length (from) (to) <br /> Filter Pack (from) I (to) <br /> SAMPLING k Bentonite (from) d (to)�� <br /> Grout (from) t (to) <br /> Holding Temperature•• Q it� _ Drilling rig type <br /> MethodLD. <br /> Auger O.D. <br /> Screening Method Completion - Stove pipe%christie box (circle one) <br /> Tracking Sheet - W n) 1: <br /> SPOILS <br /> Storage Method MATERIALS EWI.OPMENT <br /> Contamination Noted - (y n .fir r <br /> Storage Location ming type <br /> Blank ft." Screener ft. <br /> Slot size Of 0 <br /> GROE3T[NG � } �� Bags cement <br /> Buckets bentonite <br /> Depth to water id Bags sand/gravel �I <br /> Mix Ratios Filter Pack type/size :I `2- <br /> Installation Method Surge Block: - (y/ n )! <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of Method <br /> EH 29 29 r .. . <br />