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MC 'ORING WELL INSTALLATION REPORT <br /> Date: ZO �2 CONSTRUCTION <br /> Premise Address: 7Z210 Total Depth <br /> Screen Length (from) 8/ (to) / <br /> Well No.: -3 e- Filter Pat's (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (fro ) (to) <br /> 9q Drilling rig we <br /> Permit No. GL Auger O.D. l0' LD. <br /> Completion - Stove pipe/ stie box (circle one) <br /> Drilling Company. <br /> casing <br /> Driller. —fheight <br /> Corsulranc <br /> 4 <br /> Geologist �1.30VE-GRCI:ND CtiAtSTY-3CX <br /> C.:ki?L=r iCN C.^•MP:_='i 1CN <br /> Ground Saf act <br /> SPECIAL ?ER-WIT INFO. <br /> prat <br /> Dista.^ce to sewer line <br /> Domestic well on site - (y/0) 69 n <br /> If yes, location and distance - tt. <br /> con" -= <br /> SAMPLING _ <br /> sacsors <br /> Vayw r <br /> aCR <br /> Holding Temperature UJI, <br /> Method ' _ <br /> Sc:Bening Me oil <br /> Tracking Sheet - to n ) L ♦ <br /> A-.U" <br /> SPOILS g� <br /> Storage Method �5'�4 M A—1--R.I S/DEVE PW' „ <br /> Contamination Noted - ( y n <br /> Storage Location ,,rr asing e <br /> `l k4t) Blank -71 fc. Screen JL <br /> QJC_ Slot size 0? <br /> - <br /> GROUI'iNG Bags cement <br /> Buckets beitM-Ae IkJ^ <br /> Depth to water % Bags sand/gravel1�� <br /> Mix Rados Filter Pack type/ ' e I G <br /> Installation Method ,�-`� � Surge Block: - CO n) <br /> Quantity Installed Discussed with geologist: - y n) <br /> Type of method <br /> C <br />