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Q RING WELL INSTALLATION REP+,� <br /> Date: "1 CONSTRUCTION <br /> Premise Address: i `} i Total Depth <br /> Screen Length (from) (to) <br /> Well Na<> Filter Pack (from) (to) <br /> Bentonite (from) (to)- <br /> inspector: Grout Orom)- (to) <br /> Drilling rig type <br /> Perctnit Na. :Auger O.D. <br /> Drilling Company: <br /> Completion-Stove,pipe/christie box (circle one) <br /> :Driller:. pas inq <br /> height. <br /> Consultant <br /> Geologist <br /> ABOVE-CROUNO <br /> COMPLEMN <br /> SPECIAL PERMIT IIVF47.. Qraund Seufa�r <br /> Distance to:sewer;li a tri. <br /> Domestic well on site C.:y.1h). <br /> & <br /> If yes, location and distance- <br /> it. <br /> dfy rte..: <br /> SAMPLING, <br /> "anon <br /> Holding Tenperetum <br /> Method <br /> .. pnvat padc: <br /> Screennng Method <br /> Tracking Sheet y :n " <br /> lzi <br /> ll <br /> Storaige Method MATERIALS/DEVELOPMENT <br /> Contan►inatiox�.::Noted:•:.t.:y.1 n::) <br /> Storage Location: Casing type <br /> Blank Screen ftl. <br /> Slot size <br /> GR4LJTlNG Bags cement. <br /> ! Buckets bentonite <br /> Depth to water Bags sand/graveI <br /> Mix:Ratios Filter Pack type/si e <br /> Instal3atxon Method Surge I '" t: /n.:) <br /> Quantity Installed_: Discussed with' + logisr • t y.1'n <br /> Type of meth <br /> EI-I 29:29 <br />