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MONTTORPIG WELL INSTALLAitON REPORT <br /> r, - <br /> r .. <br /> Date: CONSTRUCTION <br /> Premise Address : Total Depth (o b <br /> Screen Length (from) 4O (to) �O <br /> WellNo.: VA) e63" /3 Filter Pack (from) 60 (to) 3 `I <br /> Bentonite (from) 39 (to) .3 7 <br /> Inne=r: Grout (from) (to) <br /> p Drilling rig type cAte 45 <br /> Permit No. -73 �/ Auger 0.0. � r/Z I.D. 33 u <br /> Completion - Stove pipe/chrisrie box (circle one) <br /> Drilling Company: e <br /> ,,pp Q/ casing <br /> Driller /6ZPti�( Z— height <br /> i <br /> ♦ 7 <br /> Consultant � � <br /> Geologist /�L C A30VE�GACl1ND ic � <br /> Y-30X <br /> CCWL� 5ON r N <br /> G= ni Srztaca <br /> SPECIAL PERMIT INFO . r <br /> grout <br /> Distance to sewer line lv 3 <br /> Domestic well on site - ( y / n ) tt' <br /> '/'' <br /> If yes, location and distance - tL�tt � <br /> 3 <br /> c <br /> e o <br /> ' / = c <br /> SAMPLING ZSR 7�>U slaac�on _ d <br /> Holding Temperature <br /> Method 0-' <br /> Screening Method d _ <br /> Tracking Sheet - y ntt- = ♦ tt. <br /> SPOILS <br /> Storage Method LTA k MATERIALS/DEVELOPMENT <br /> Contamination Noted - aY n ) n �C <br /> Storage Location (M /I Casing type 7 tr <br /> Blank q0 fr. Screen ZO ft <br /> Sloc size / <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 4�/i4 Bags sand/gravel Z <br /> Mie Rados Filter Pack type/size an2ejc . -aj <br /> Installation Method Surge Block: - NIQ <br /> Quantity installed Discussed with geologist: - ( y / n ) <br /> Type of method <br /> vGU /�� !3 7.D <br />