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M,O—, TORING WELL INSTALLATION REPORT ,./ <br /> Date:—O - I CONSTRUCTION <br /> Premise Address: Total Depth �` r <br /> f , Screen Length (from) a� (to) r <br /> Well No.: I Filter Pack (from)�_Ro)�T_ <br /> Bentonite (from) �_(to) a <br /> Inspector. G�ff Grout (from) (to) ol-b <br /> �— �— Drilling rig type aele� <br /> Permit No. Auger O.D. I.D. <br /> GG Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: J .�e-C✓�(�V�� <br /> Driller: casing <br /> height <br /> Consultants FM=7=6L17 <br /> Geologist <br /> ABC <br /> VE-GACUND CNRLM-BOX <br /> CCNFLE'rZN CCMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Sloan <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> tt. <br /> a <br /> = o <br /> _= c <br /> a <br /> SAMPLING �lorad = c <br /> socicn <br /> Holding Temperature = gr, ,I Pack <br /> Method -" <br /> Screening Method 1 <br /> Tracking Sheet - ( y/ n ) <br /> ft. <br /> SPOILS tAS� <br /> Storage Method MATERIALS/DEVEI.OPMENT <br /> Contamination Noted - y n ) qtr v <br /> Storage LocationA Casing type <br /> y Blank D ft. Screen ft. <br /> C Slot size b'3- h± <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />