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dTORING WELL INSTALLATION REPORT <br /> f <br /> Date: 1 `72-93 CONSTRUCTION <br /> Premise Address:-J.��4i1� — Ujffl Total Depth <br /> I Screen Length (from)„ -�fl (to)�,-5� <br /> Well No,: �� __ Filter Pack (from) (to) 43 <br /> Bentonite (from) {to) <br /> Inspector: : Grout (from)_•,g� <br /> Drilling rig type <br /> Permit No, 2'.35010 _ Auger O.D. I.D. <br /> w Completion - Stove pip iristie (circle one) <br /> Drilling Company: f7. <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist T <br /> ABOVE-GROUND CHRM Y-BOX <br /> OOWLETCN COWPLEnON <br /> SPECIAL PERMIT INFO. G=nd Surface <br /> Distance to sewer Iiae gram <br /> Domestic well on site - (y/ ��ft, <br /> If yes, location and distance - �- <br /> .y <br /> IP <br /> y: m <br /> 4+. O <br /> SAMPLING slaroi c „ <br /> "cicn <br /> Holding Temperature <br /> Method ' = gn Pack <br /> Screening Method <br /> Tracking Shcet (y/ n ) <br /> iL <br /> SPOILS <br /> Storage Method �1� MATERIALS/DEVELOPMENT _ <br /> Contamination Noted- (y/n } <br /> Storage Location Casing type•_ <br /> Blankft. Screen ft. <br /> Slot size DZ . <br /> GROUTING Bags cement <br /> Buckets bentonite l <br /> Depth to water 4�D Bags sand/gravel <br /> Mix Ratios I 411 !;6& _ Filter Pack type/ 'ze :0---1Installation Method Surge Block: - n } <br /> Quantity Installed x 3 Discussed with geologist: - n ) <br /> Type of method <br /> EH 29 29 <br />