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M PORING WELL INSTALLATION REPORT <br /> LTd / ak 9-6 s`..t 2,0- 7 < «.�¢ 5/ G..�6 5-0 ye��. <br /> /fit.✓, ®/V ' <br /> qq _Oo2, <br /> Date: `� ` ` 3 CONS-1 RUCTION <br /> v� S <br /> Premise Address: f Total Depth / <br /> p � Screen Length (from) (to) Zr <br /> Well No.: AVOW / 1. PZ tM os Filter Pack (from) /5 (to) <br /> ''�� -41- 7T o ate d�(from) (to) <br /> Insoector: Grout (from) (to) <br /> Drilling rig type 8-53 <br /> Permit No. Auger O.D. 8' I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company , ,�,Q�t <br /> J casing <br /> Driller.— `-i- ^� height o <br /> J C <br /> r7171 <br /> Consultant t <br /> '' JJ _ <br /> Geologist CHAJSTY-BOX ' <br /> COWPtiI CN C _ <br /> G=r d Sufis <br /> SPECIAL PER-kIIT INFO. <br /> prat <br /> Distance to sewer line IVIA 8 <br /> Domestic well on site - ( y/© fL <br /> If yes, location and distance - <br /> O <br /> tIOILod ,.' <br /> SAM?I—ING socdon <br /> tea• g _vw pack <br /> Holding Temperature <br /> Method <br /> Screening Method ' <br /> Tracking Sheet - n <br /> ft. <br /> IL I <br /> SPOILS / <br /> Storage Method Gc� e� A 54 ��� MA—,--.- ALS/DEVELOP. NT <br /> Contamination Noted - y n) 'I S /" 4p P�C <br /> Storage Location Ove Casing type <br /> Blank /0 fr. Screen S fG <br /> Slot size - 00Z - <br /> GROLMNG Bags cement <br /> Buckets bentonite .ez ae 6 d ^ <br /> Deorh to water = Bags sand/gravel =` 3 <br /> Mix Rados 2� 63 Filrer Pack typesize JC <br /> Installation Method Surge Block: - ( y/ n <br /> Quantity 2'3 G�cv' -ea-�-�— �t-_� Discussed with geologist: - (y <br /> ty Installed <br /> Type of method <br />