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WTORING WELL INSTALLATION REPOP* <br /> Date: kLZ11Af(4 68 CONSTRUCTION <br /> Premise Address: Total Depth e2'7,S�oet- o// Svtg} .27frz1 <br /> Screen Length (from) 2Z ' (to) 17 <br /> Well No,: M W- (4 A Filter Pack (from) 27 ' (to) /.171 <br /> Bentonite (from) /S' (to) /71 <br /> Inspector. _ Y it k t Me 6/?Hfi"i Grout (from) 13 ' (to)_2ur r <br /> —� Drilling rig type C/n - 9,5- <br /> Permit <br /> g,$'Permit No._ U65'-22/6 R Auger O.D. Xi yj,&hej I.D. el <br /> ,p Completion - Stove pipe/ Is[ie boy (circle on2) <br /> Drilling Company: (/-GSG'��L �r', l�' n& <br /> Driller:_ JgL)L4 mr- Arrov6 � casing <br /> Telt Arenas tt Jasoa Larsak height <br /> Consultant D 1 S 4 <br /> Geologist ?rv-7t Krekbie/ - Ajj('/}D,7'.Y <br /> 1i finkn� Htillin�aWDrtA -HR6AP-TS ABOVE-GROUND X <br /> COWLETION CCMPLEf CN <br /> SPECIAL PERMIT INFO. Ground Surlaca <br /> Distance to sewer line 1/n n.01.i n Qrcut <br /> Domestic well on site - (y/9 * /3 ft, <br /> If yes, location and distance - /S ft <br /> �Q rcc n <br /> 0 <br /> SAMPLING 12- <br /> - 0 3 �lorad <br /> saricn <br /> Holding Temperature_ of A IL 6,4 <br /> Method i9 6„>' _ _ travel pad( <br /> Screening Method `Z 0,3 r _ <br /> Tracking Sheet - y n ) -2y 0,3 <br /> edwi n0doslr��� , -ZL °''fin• = z7' tt, <br /> SPOILS <br /> Storage Method -Vi Z.4U00. MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ ) <br /> Storage Location_ DX's te. Casing type .2-} vu, 90 <br /> Blank 17 ft. Screen i cb ft. <br /> Slot size <br /> GROUTING Bags cement / - l t1 r <br /> Buckets bentonite d?w Sd-# U/fV -r<'�m va <br /> Depth to water ', . 8� Bags sand/gravel 9 5D <br /> Mix Ratios G ,ha s t{7 Ib 1_^' o?a2 //^d✓ Filter Pack type/size <br /> Installation Method ov � ( yIl'-s�� Surge Block: • ( y/ n <br /> Quantity Installed J�/;YC - Discussed with geologist: <br /> EH 29 29 47"I6 b �72, Type <br /> of method <br />