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OMTORING WELL INSTALLATION REPO* <br /> Date: A u6 us /4 oaao 15 aoo,7 CONSTRUCTION <br /> Premise Address: Torp oto Total Depth "c2 () <br /> Screen Length (from) l- U (to) I/ o <br /> Well No.: M W- 9 Filter Pack (from) /2(" (to) l0 7 <br /> / r Bentonite (from) 16 ? (to) /0 S <br /> Inspector. V1"C�C� M ��rTh�n Grout (hom) /OS- (to) TyJ' <br /> Drilling rig type Marl rn A/ <br /> Permit No. U S/s- toG Auger O.D. A j.IA T.D. <br /> Completion - Stove pipe/cliristie box (circle one) <br /> Drilling Company;. G r�G1 LI �Y, I� �n G( <br /> Driller: son Ale* � 'T casing <br /> PQUS+o 14,t.tas Cpl' je Rq kpw height <br /> Consultant Ad✓a.,,., d e 6n ;rnnwela F �te,(AGE 4 <br /> r <br /> Geologist ,4 1(,4 _ 20/4 V, fCJ fiIsEI - <br /> A80VE-GRCUND <br /> M� Crzar� CRcb) COI.IPLETION C>iA <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line ° �0 �Qk� Oram <br /> Domestic well on site - ( y AD Jos-. ft. <br /> If yes, location and distance - ft <br /> : = a <br /> I D r.-acl; a - al/ zero _ o <br /> SAMPLING PI Ise al '70 7s� sol .orncn <br /> e 95 /oa /05 WaJ3P rn — <br /> Mcthod Temperature � r✓ , ��° <br /> Method ic¢ in cool ,- �Y�F <br /> Screening Method P I D l r; <br /> Tracking Sheet - (' n) _ <br /> I tai ogcl - Cl 4-a II0 'I's a0 <br /> SPOILS -120 ' <br /> Storage Method ✓ r mS MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) <br /> Storage Location /!n t,f Casing type , n L'4 <br /> Blank il!) ft. Screen l0 ft. <br /> Slot size n 2 h`' <br /> GROUTING Bags cement 20 b 's <br /> Buckets bentonites F'O-1 Plug 59LL�� <br /> Depth to water lkr,,r c� n Bags sand/gravel q /OD <br /> Mix Ratios q4t- N a" a7 c I � Filter Pack type/ ' e 3 _ <br /> Installation Method a ems Surge Block: - n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> -Q Type of method �J L�frig v <br /> EH 29 29 <br />