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MO' -ORING WELL INSTALLATION REPORT <br /> Dace: - �la CONSTRUCTION <br /> P-em,"se Address: I�gQs s' Total Depth /S <br /> ''/ Screen Length (from) 15 (to) <br /> Well No.: Gt/ ' l Filter Pack (from) OS (to)_ Z___—_ <br /> Bentonite (from) O (to) ' o i <br /> Insaector: 44Grout (from) Z (to) 0 <br /> Drilling rig type 23-S7 <br /> Per^.it No. <br /> fl -01(o 7 Auger O.D. /6 1.D.! 7 y" <br /> Compledon - Srove pipe/christie box (circle one) <br /> Drilling Company: -- �• <br /> casing <br /> Driller: T <br /> ���. ,Q� .c:_ T height <br /> Consultanr <br /> Geologist \ <br /> �firPL+i 1C�'i C#ifilSTZ'-80X <br /> COMPL E 1 IcN <br /> Ground Ssrtact <br /> SPECIAL. PERMIT INFO. <br /> grout <br /> Distance to sewer line N q <br /> Domestic weil on site - el <br /> tL <br /> If yes, location and distance - �' <br /> reg C <br /> O <br /> SAMPLING $*tsars <br /> Holding T emgm�Pack <br /> rature ""� _ , <br /> Method <br /> Sc:eening Method <br /> TracIdng Sheet y) n ) /� ft. ,�► _ . <br /> SPOILS <br /> Storage Method MA-1--RIALSMEVELOPMENT <br /> Contamination Noted - (y/ n) .i �f,, Ale <br /> Storage Location 01- .a-c.� Casing type <br /> Blank____.� ft. Screen Z ft <br /> Slot size <br /> GROUTING Bags cement 2• <br /> Btt&cets benronite z <br /> DeDdh to water Bags sand/gravel <br /> Mix Ratios ( Filter Pack type/size •S <br /> Ins:alladon Method Surge lock: - (y/ n )N 4 <br /> Quancry Installed ' Discusse with geologist: - Cy/ n )y/ n ) <br /> Type o[me od <br />