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MOTORING WELL INSTALLATION REP-stT <br /> NT <br /> Dater � � CONSTrtUCITCtN <br /> . Zhu S Total Depth <br /> Premise Address• Screen Length (from) (to} <br /> N,,,� Filter Pack CFroat) (to) <br /> Well No.• J 1 ► �' - — Bentonire (from) (to) <br /> r Grout (from) (to)— <br /> !nspector. i-° Drilling rig type <br /> Auger O.D.. . I_D. <br /> Permit No. Completion•Stove pipe/christie box (circle one) <br /> Drilling CompanT- <br /> CB , casing <br /> [fir; height- <br /> • 7 � <br /> ConsultantM <br /> .� f <br /> t I E&Z-GROUND r• C,HWS-1 Y-Sax <br /> C."IrPL.R']ON " C;7MPL=TiCN <br /> Ground 5�� �-�"•^�'^� <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer lin <br /> Domestic Well on site - C y/ a) <br /> If yes, location and distance - <br /> ;7 _ ... <br /> a <br /> elottad a, <br /> S�G sac-cn <br /> N = <br /> ?-folding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> Storage Methvd MATERIALS EVEL0P`V_ � <br /> Contamination Noted - [y/ n) Casing type <br /> Storage Location Blank fr. Screea <br /> Slot size <br /> Bags cement <br /> 02LMNG Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pact typesize <br /> Mix Ratios <br /> Instasilation Method Surge Block: - C y/ n) <br /> Quantity Installed Discussed with geologist - C y/ a) <br /> Type of method <br /> EH 29 29 <br />