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NtY6IT0It1NG WELL.INSTALLATION REPOPO <br /> Date: " 1 - �� CONSTRUCTION <br /> Premise Address: Total Depth, d <br /> Screen Length (from) 7q (to)w3t} <br /> Well No.: YY1 to - 4 Filter Pack (from)_ Sq (to) 3Z <br /> Bentonite (from) 52- (to) 3 Q. <br /> Inspector. Grout (from) 3 e -(to) I <br /> Drilling rig type y-J&B f <br /> Permit No. Auger O.D. LD. SS /�L ` <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: I36c3flt,��� <br /> Driller: \1 PC KI [ <br /> Tcasing <br /> T height <br /> Consultant PTJ`] <br /> Geologist Docj C� -- <br /> ABOVE-GRCUND &ON <br /> COMPLETION <br /> SPECIAL PERMLT INFO. Gmund 5estaca <br /> Distance to sewer line ink- Qf°Lt <br /> Domestic well on site - (y <br /> If yes, location and distance - ft- <br /> v� m <br /> w V <br /> SAMPLING slot" <br /> sacicn <br /> Holding Temperature C- ' <br /> Method H5 Jar 55 r Ravi <br /> Screening Method I — <br /> Tracking Sheet y� n )_ COQ <br /> 46— 40 6�6 . <br /> SPOILS em V" <br /> Storage Method DO e Z U ILAe24'0-t t'j MATERIALS/DEVELOPMENT <br /> Contamination Noted Aq/ n) O is Qrnv <br /> Storage Location br-,3 5 r sE Casing type O <br /> BIank 3tj ft. Screen Z'S ft. <br /> Slot size h 4T71) <br /> GROUTING Bags cement L V aA_ <br /> Buckets bentonite Q f p (Z sem} <br /> Depth to water Bags sand/gravel I-L 4 <br /> Mix Ratios 1 Filter Pack type/size 3 <br /> Installation Method s Surge Block: - (y <br /> Quantity Installed Discussed with geologist: - n ) <br /> Type of method_ 1. � <br /> EH 29 29 <br />