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. NITOPdNG WELT. INSTALLATION REPC <br /> 0 <br /> Date: CONS'T'RUCTION <br /> Premise Address : $� D Total Depth <br /> /'t Screen Length (from) (to) <br /> Well No, : 4X VW Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. _ Y.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: caei.ng <br /> A � <br /> he light <br /> Consul[ant ���/� � <br /> Geologist C"LL <br /> ABOVE�GRCUNO <br /> COWLETION C7isIm-aox <br /> COMPLETICN <br /> SPECIAL PERMIT INFO. Around SuAxy <br /> Distance to sewer line�A L/ <br /> proof <br /> Domestic well on site � ' ri <br /> If yes, location and distance - <br /> ft. <br /> K. <br /> c <br /> SAMPLING eloNad <br /> /C escticn <br /> Holding Temperature <br /> Method — Pr"wPack <br /> Screening Method ZVI — <br /> Tracking Sheet - ( y / n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) <br /> Storage Location Casing type <br /> Blank.fro Screen_ ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets berntonite <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 />