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MC - 'TOPING WELL INS TALL4iION REPORT - <br /> II ,. <br /> Date: �! ZU/PZ // ky CONSTRUCTION <br /> Premise Address : N � D Total Depth 7� <br /> Screen Length (from) 7b (to) S <br /> Well No. : Filter Pack (from) � (to) S (o <br /> Bentonite (from) `jio (to) s _ <br /> Inspector: Grout (from) s` (to) d <br /> Drilling rig type C'rrl6 <br /> Permit No, Auger O.D. /0 % I.D . <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Dr lle r <br /> he <br /> Consultant <br /> / A <br /> Geologist (y4oez i� ABOVE-GRCUNO <br /> CCkPLT10N CIfAISTY-30X <br /> CCMPICN <br /> ndSuews <br /> SPECIAL PERMIT INFO . <br /> gro41 <br /> Distance to sewer line , 5 d C ` (4 <br /> Domes dc well or, site - ( y /0MOILS� ft' <br /> If yes, location and distance - 5!9 ft <br /> ft- � _ <br /> — o <br /> dotmd = `c <br /> SAMPLING sx7on <br /> Holding Tempera eA � " <br /> Method M• <br /> Screening e'�I rhod 0 U/0 �f <br /> Tracking Sheet - y n ) �_ 7 <br /> SPOILS <br /> Storage Method 6711 f 4cwL c4 �/i ° `�_ MATERIALS/DEVELOPMENT <br /> Contamination Noted - y_ r} ) ! �r/ s� 4 <br /> Storage Location Oti Casing type <br /> Blank h9 ft. Screen Z 0 fr. <br /> Slot size O Z <br /> GROUTING Bags cement <br /> Buckets bentonite_/ 2 <br /> Depth to waterBags sand/gravel- 8r2 <br /> Mix Ratios f� Zg' ��— Filter Pack type/ 'ze 3 <br /> Installation Method OQ Surge Block: - ( / n ) <br /> Quantity Installed — Discussed with geolog$i�st: - y n ) <br /> Type of method /1 uh%> C rrn t r 242 " I <br />