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"TORING WELL INSTALLATION REPOR, 1 <br /> Date:` CONSTRUCI7ON <br /> Premise Address-`Y/V' lh�07 ✓fi Pm Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) <br /> (to)— <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company; <br /> Completion - Stove pipe/christie box (circle one) <br /> ��/Y� <br /> Driller: casing <br /> T height <br /> Consultant J <br /> —qVTGeologist <br /> ABOVE-GAG'tJND CHAISTY-80X • <br /> COkl�+L.ETION COMPtETICN <br /> SPECIAL PERMIT INFO. Ground sudsy <br /> Distance to sewer line gra <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - �- <br /> SAMPLING aEarod <br /> aaCscn <br /> Holding Temperature gravoI pack <br /> Method ` _ <br /> Screening Method — <br /> Tracking Sheet - (y/ n } — <br /> � A. <br /> SPOILS <br /> Storage Method Vl�" MATERIALS EVELOPMENT <br /> Contaminadon Noted - (y/ } <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> 1 Buckets bentonite <br /> r <br /> Depth to wate � 9 Bags sand/gravel <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 />