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•#/ - 'I,hg 0- 083�-b ) dy G 6A6< C Ion; <br /> 0 RING WELL INSTALLATION REPORT <br /> Date:�O /`f CONSTRUCCION <br /> Premise Address:--24-�M X- Ujj 0.4j Total Depth /hN <br /> �- Screen Length (from)' ` (to) <br /> Well No.: �/� - Filter Pack (from) (to) <br /> Bentonite' (from) l_ (to) 3 <br /> Inspector: . /Q/On//i— Grout (from) � M'7 <br /> (to) 0.!5- <br /> Drilling <br /> .!5 Drilling It type <br /> PermitNo.. Auger O.D. I.D. <br /> Completion- Stove pipe/christie box (circle one) <br /> Drilling Company.. �, G♦r <br /> Driller: casing <br /> Aheight <br /> Consultant M <br /> ONWY6 i, gi 4-k <br /> Geologist �P- nr��Jrt✓�Fz�i J .e - <br /> ABOVE-GROUND CFWISfY-BOX <br /> 00wLEnoN COMPLETION <br /> SPECIAL PERMIT INFO, Ground Sulx <br /> Distance to sewer liner/il/_ i�/ ®rout Cl:7 •^ <br /> Domestic well on site - Cy/n) 4 1 1 <br /> If yes, location and distance - ft W <br /> 96 ft. <br /> T-' <br /> 4 - m <br /> SAMPLING S/�N��I/A2S Ta fes() = o <br /> el9ttad _ <br /> n <br /> Holding Temperature <br /> Method /C <br /> Screening Method <br /> Tracking Sheet <br /> v" Ile) fte _ ft. Pg. <br /> SPOILS /5j. btuA J <br /> Storage Method 2'nym Ot'l h 1 rL ►N (V;.Vefi4 MATERIAiS/DEVELOPMENT <br /> Contamination Note n) <br /> Storage Location E-1 Casing type ani /'�• �bL <br /> Blank ft. Screen 6L< ft. <br /> / T V Slot size <br /> GROUTING �/ / Bags cement -?-47.X <br /> //^ Buckets bentonite 0 Urq«c <br /> Depth to water Wb `T $ /�►`ja-S Bags sand/gravel INA <br /> Mix Ratios Filter Pack type/size <br /> Installation Method /Vl/ <br /> i- AS__—_—._.._S.urge_Block;_(_Y-/_n_) <br /> Quantity Installed_ yi�j# Ay�-� 77LS�•fl� Discussedd with geologist: - (y/ n) <br /> EH 29 29 Type of method <br />