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OMTTORING WELL INSTALLATION REPOT* <br /> Date: f 3 1? 2 d 0 CONSTRUCTION <br /> Premise Address: l4 t TUrYI ,o/f6�— Total Depth GQ jcee-*- <br /> �q Screen Length (from) (to) d <br /> Well No.: 1V I W — I WhVe,, Q e Y?/rr�l� Filter Pack (from) (to) <br /> / Aq - Esc r j Bentonite (from)_ 48 (to) <br /> Inspector. Grout (from) (to)n - <br /> J Drilling rig type InAirl W <br /> Permit No. Auger O.D. 8 �_ I.D. 4. 15" <br /> Completion - Stove pipe/duistie box (circle one) <br /> Drilling Company: /,"ra -� Y r <br /> Driller: \JQ.S!'rt keq Se9n eRakora� casing <br /> raos HCl vaJOJ �A^�n, a(Y� 8'nl�� height <br /> Consultant 77/1 <br /> L ��21 /LrYt6,9 <br /> Geologist f 4 �8 VL <br /> ABOVE�iACUND <br /> as i n inC--cf t ` ����) C0WLETION COMPLETMN <br /> SPECIAL PERMIT INFO. G=nd SU12" <br /> Distance to sewer line a VIA <br /> Domestic well on site - (y (t. <br /> If yes, location and distance - 5 D _ }t. <br /> tt. <br /> PI �D . e s talo. 6�t Zlo; <br /> SAMPLINGatcicn <br /> sS 2 tsyf Sd'- SG alorod _ y <br /> Holding Temperature '�bC /ton"lu pavetpadt <br /> Method <br /> Screenin; Method <br /> Tracking Sheet - y n ) ?. <br /> h clra�,,bo .or�oY = D <br /> Them k14-5' 'C ft. ft. <br /> ": <br /> t4,r a v 13,1Z o01 Fh i XJ ��J i ot-FM <br /> SPOILS d the sa ( haGIA� lett' L'o/d� . d�/�; l�/DEJ h reL b�vurn f� <br /> Storage Method S' r t MATI�RiALS— VEI.OPMENT <br /> Contamination Noted - // n ) <br /> Storage Location ma Casing type <br /> Blank Screen /b h• <br /> Slot size 0 ' 0 ° <br /> GROUTING 044;},Bags cement / 12444 A b a <br /> ftj PIU3 - Buckets bentonite I v Q y b) <br /> Depth to water ` i 1tv 6); Eves t} WdoS20 S'bs Bags sand/gravel <br /> Mix Ratios ^' -` q s /*�Q�¢— Filter Pack type/size <br /> Installation Method 8rov 0-r3 Surge Block: - ( y/ n ) <br /> Quantity Installed & t 0 Discussed with geo ogist: • n ) r <br /> Type of method ✓�- U, rnt Mi <br /> d r � � <br /> EH 29 29 T11 4 9 �te4 L/0 � �� <br /> L16'le &P<>� 47 <br /> u r�.S � <br /> / i� �_ e lllLrf LrJQ,f� <br /> 4 r <br /> -�-l�0 1-�..y� `�c�-••t Q��il orr� ���f;ax� <br />