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I"- <br /> %.OMRING WELL INSTALLATION REPOhd <br /> Date: CONSTRUC ON <br /> Premise Address: �. Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) —(to)� <br /> Bentonfre (from) (to)— <br /> Ins pitor. <br /> to)Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Peimit No. Auger O.D. I.D. <br /> Completion-Stove pipe/chrisd box (circle one) <br /> Drilling Company: <br /> Dn11er: <br /> CAGLn <br /> j5 <br /> Consultant <br /> LT heighR 0- IFt <br /> 7EW <br /> Geologist,,..• ». <br /> OO14PLE ION CCMPL -M <br /> OMPL8T10N <br /> RIM EMW . �'i Ground SOA= <br /> Distance to sewer fine �.--- 9M <br /> Domestic well on site - y n) <br /> 1f yes Ovation and ilia a ft. <br /> & <br /> it. <br /> SAMPLING Waited _ $ <br /> Holding Tem tore v swan <br /> �;. "_ gray.l paclt <br /> Method <br /> Screening Method <br /> Tracking Sheet • n . <br /> _alt. __ '•" _ � <br /> SPQILS t <br /> Storntge Method �c:C> MATEWALS(DMMhQPMENT <br /> Contaminatiots N ed - y n) <br /> Storage Locatio Casing type <br /> Blank fL Screen ft. <br /> Slot size <br /> GRO[TRNi3 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 />