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e <br /> 140NITOMG WELL.INSTALLNMON REPO <br /> Date: 1r' RJ� CONSTRUCTION <br /> � <br /> Premise Address:i0 � U D Total Depth <br /> Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Well No.: ��— <br /> Bentonite (from) (to). <br /> Grout (from). _(to) <br /> Inspector. ,!C7 R Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion:Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> cas—ina- <br /> Driller height <br /> 7 <br /> Consultant_ Q 9.� <br /> Geologist AI&E-WOUND <br /> CCt4PL� MN CCCMpLRtCNMPL MCN <br /> sureeve <br /> SPECIAL PERMIT INFO Grwxld <br /> WOA <br /> Distance to sewer <br /> Domestic wet on site - (y �- <br /> if yes, location and distance - fL <br /> n ^ a <br /> 40 <br /> , — <br /> _ o <br /> SAMPLING �O 3 <br /> season r� <br /> Holding Temperaure .r 9M,r1 w,�,* <br /> Method <br /> Screening Method ;� = <br /> Tracldng Sheet - (y/ n) <br /> n- <br /> PS OILS <br /> Storage Method MA OPNEENT <br /> Contamination Noted - (y! n) <br /> Storage Location Casing tYPe <br /> Blank fL Screen ft <br /> Slot size <br /> GROUTING Bags <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mia Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/a) <br /> Type of method <br /> EH 29 29 <br /> a <br />