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JMTORING WELL INSTALLATION REPO. <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from)-(to)- <br /> Inspector. <br /> from) (to)Inspector. Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GACUND CNAIS7Y 80X <br /> COMPLETION CCMPLEnCN <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - <br /> � ft. <br /> SAMPLING sionod <br /> saricnZN <br /> <• __ <br /> Holding Temperature = �� <br /> Method " _ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) ' <br /> tt. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen fr. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 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 />