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MOW TORING WELL INSTALLATION REPORT <br /> Date: 1 I- -q l _ CONSTRUCTION <br /> �� 4� Q A U 6� Total <br /> Premise Address: Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type --b7.c) uuGN- <br /> Permit No. Auger O.D. I I.D. <br /> \ <br /> Drilling Company: e-1 LU fj6,- Completion - Stove pipe/christie box (circle one) <br /> u <br /> Driller: lei casing <br /> height <br /> Consultant ' ot-:;r —QW7:F <br /> Geologist J L'LS96-(' - <br /> Ag0V -GRCUND CtiASSTY-80X <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line of0"t <br /> Domestic well on site - n) �.,.__ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> V' 0 <br /> SAMPLING WS►^rL: Y>106LL>✓ L-?c9.' <br /> SEm l l0 L Ik sec�cn <br /> „•: <br /> Holding Temperature <br /> Method ' — pack <br /> Screening Method r' <br /> Tracking Sheet - (y/ n ) -Y <br /> it. <br /> SPOILS <br /> Storage Method; �� T'e�\-, 0TZ MATERIALS/DEVELOPMENT <br /> Contamination Not d - y n) <br /> Storage Location C. De Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water _ Bags sand/gravel <br /> Mix Ratios �(n Filter Pack type/size <br /> Installation Method. k) Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />