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ANTTORING WELL INSTALLATION REPORT* <br /> Date: J 3 00 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) e'S (to) (as <br /> Well No.: -),q W ;2— 1 Vn—L&�Z Filter Pack (from) (n s (to) to3 <br /> Bentonite (from) Ifl 3 (to) (oO <br /> Inspector. �' z Grout (from) ( n (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. dc /'Y I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company: 4 -lie U <br /> Driller: � �r casing <br /> he±qht <br /> Consultant <br /> Geologist 1L^- /o'tC, <br /> ABOVE-GFiCUND iSTY 20 <br /> CO&FL_crCN N <br /> SPECIAL PERMIT INFO. Cxcurd Stzfact <br /> i T <br /> Distance to sewer line z, )S grout <br /> Do tic well on site - On ) ft. <br /> If es, ocation and distance - n, <br /> I o fs. <br /> = o <br /> — o <br /> SAMPLING alorwi <br /> aocicn <br /> Holding Temperature Sti.,...e Ko m tt7 / = fraud past <br /> Method <br /> Screening Method D <br /> Tracking Sheet - n) <br /> h, = ft. <br /> SPOILS <br /> Storage Method cln .o cfv MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) d , <br /> Storage Location :517 V Casing type---Z—V6- <br /> Blank—ft- <br /> ype wL <br /> Blank ft. Screen . ft. <br /> Slot size . 063 <br /> GROUTING Bags cement <br /> Buckets bentonire <br /> Depth to water ns 6l7 Bags sand/gmvel OV a-- <br /> Mix Ratios Filter Pack type/size f'//Q <br /> Installation Method Surge Block: - (0 n—) <br /> Quantity Installed Discussed with geologist: - (Y/ n ) <br /> Type of method jj d <br /> EH 29 29 <br />