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--1VIONITORAIG_WELD INSTAUAMON Rl f <br /> Date: ������ DS <br /> _ CONSTRUCTION <br /> Premise Address: 7 , Total Depth R O <br /> Well No.: <br /> A4(Aj /0 6 Screen Length (from) 9 o (to) o <br /> Filter Pack (from) ?D (to) <br /> Inspector. Bentonite (from) G� (to)66 <br /> Grout (from (to)� <br /> Drilling rig <br /> Permit No. Auger O.D. I.D. <br /> f Completion -Stove pipe/christie box (circle one) <br /> Drilling Company:-l'1LL <br /> Driller: <br /> v-. casing <br /> height <br /> p Consultant-- <br /> nt <br /> Geologist <br /> ' ABOVE-GROUND <br /> COWLECION CITY-80X <br /> COMPLETION <br /> �_ BPE®AL PERMIT INFO. Ground Surface <br /> Distance to sewer line 4r«a <br /> Domestic well on site - (y/n) <br /> U yes,location and distance - <br /> � <br /> S �0C. <br /> d Holding Temperature .» <br /> Method_ /� � ii = 9m; Pack <br /> S <br /> ScreenjWJAethod t a. <br /> Tracking Sheet <br /> 4. = <br /> SPOILS <br /> StorageMethod �M MATERIALS/DEVELOPMENT <br /> Contamination Noted- (y <br /> Storage Location Casingc� <br /> Blank -LQ--ft- Screen 2-D ft <br /> Slot tent <br /> GROUTING Bags ,.2,3 <br /> Buckets bentonite 5-6 _ <br /> Depth to water Bags sand/gravel 1111wo. <br /> Mia Ratioslh1e r Filter Pack type,/size <br /> Installation Method Surge Block: - (y/ ) <br /> Quantity Installed Discussed with geologist: n) <br /> Type of method <br /> EH 29 29 <br />