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q <br /> MON: XNG WELL INSTALLATION REPORT <br /> Date: 3 CONSTRUCTION <br /> Premise Address: V'n Q,C Total Depth. J2 <br /> Screen Length (from) 5D (to) 5 <br /> Well No. : 9 6 R CLE Filter Pack (from) 5D (to) M:5� <br /> Bentonite (from)52 , #50 (4 <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. 3 3 Auger O.D. I.D. <br /> Completion - Stove pipe/cliristie box (circle one) <br /> Drilling Company: <br /> L <br /> Driller: It�YYJ casing <br /> IItt1 � � height <br /> Consultant W fl f_ <br /> Geologist � • l7( U11l.tUll1Y •- r <br /> ABOVEmGACUND CHAISIY-BOX <br /> 00MPt.E *N COMPLETION <br /> SPECIAL PERMIT INFO. Orcurd suAaca T <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - ( y / n ) ft. <br /> If yes, location and distance - <br /> . ft. <br /> e � <br /> SAMPLING slorad = E <br /> a 'cn <br /> Holding Temperature = ysavd pads <br /> Method _ <br /> Screening Method r s <br /> Tracking Sheet - ( y / n ) <br /> fte <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - Q/7 n ) �VC <br /> Storage Location Casing type <br /> Blardc � ft. Screen ft. <br /> Slot size 2 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size L)Pd C / 1L1 <br /> Installation Method Surge Block: - ( y / a ) <br /> Quantity Installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> EH 29 29 <br />