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1 �41TORING WELL INSTALLATION REPORy„� <br /> Date: —2 < CONSTRUCTION <br /> Premise Address: �y� U /3L P34/^4Y,Total Depth <br /> Well No.: Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Bentonite " (from) (to) <br /> Inspector: , _ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger Q.D. I.D. <br /> Drilling Company: Completion - Stove pipe/cluistie box (circle one) <br /> Driller: �^l cas Ing <br /> C J height <br /> -qVT <br /> Consultant 1!71 <br /> T <br /> Geologist '' 1 J� ... <br /> ABOVE-GRC'JND CHRMTY-BOX <br /> t:OAFLETCN COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer Iine Qrcut <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - �. <br /> 7, M <br /> SAMPLING <br /> flora i :r <br /> cn <br /> Holding Temperature 1�� troctiN <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n } <br /> tL <br /> SPOILS <br /> Storage Method s v _MA_T_E_RIALS/DEVEI.OPMENT <br /> Contamination Noted - ( /n ) / <br /> Storage Location J/ Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> / Buckets bentonite <br /> Depth to water= C�_ Bags sand/graveI <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity InstaIlcd Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />