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A40NITOPJNG WELL INSTALLATION REPT--P- <br /> Date: !G tJ" J�1 CI CONSTRUCTION <br /> Premise Address: l�� Total Depth l <br /> Screen Length (from) Z (to) <br /> Well No.: Filter PackZ: '(from) - (to) 4;� <br /> Bentonite (from) (to) ?5-- 1- <br /> Inspector: <br /> `Inspector: �G�cL Grout (from) (to) <br /> Drilling rig type MSA, Ff" <br /> Permit No. Auger O.D. 2 I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant 77 <br /> Geologist •- <br /> ABOV_-GROl1ND C4qR3STY-BOX <br /> CONPLETION COMPL—ETION <br /> SPECIAL PERMIT INFO. G=nd Sumacs <br /> Distance to sewer line proof <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING ,:s = <br /> slotted <br /> aoo5on =_ <br /> Holding Temperature g ,VV1 paCk <br /> ;. <br /> Method <br /> Screening Method : <br /> Tracking Sheet - ( y/ n ) <br /> IL "V — M <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) /I -.i, <br /> Storage Location Casing type '9 CJ4 <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Ydis bentonite d n vc vs e Ll /kcal v. / <br /> Depth to water Bags sand/gravel -Z <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 />