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` (rTCRJNG WELL, INSTALLATION REPOT"' <br /> .. ,. . " <br /> WW <br /> Date: CONSTRUCTION <br /> i <br /> Premise Address: -2495LI Total Depth O 3 <br /> Well No.: � Screen Length (from) (to) <br /> Finer Pack (from) &13 (to) (o <br /> Bentonite (from) —(to) <br /> � <br /> Inspector: Grout (from) (to) b ! <br /> Drilling rig type—CAG 75 <br /> Permit No. O S Auger O.D. I_D. J <br /> Completion - Stove pipe/christie box. (circle one) <br /> Drilling Company- j <br /> f <br /> casing <br /> Driller Height <br /> Consultant <br /> Geologist wil _ ABOVE-GROUND <br /> COWL�-TCN «. C�iR1STY-aOX <br /> COMPLE-i IC <br /> .„. G=nd Surface i <br /> SPECIAL PERMIT INFO. '” <br /> grout <br /> Distance to sewer line- <br /> Domes dc <br /> ineDomestic well on site - { y <br /> Ii yes, location and distance - tL <br /> - O i <br /> C <br /> SAVIPLING <br /> aa�o i <br /> Holding Tempera cure " <br /> 1rlerhad <br /> Screening Method PMRE <br /> Tracking Sheet y nft. , <br /> r 4 r <br /> SPOILS -Al N_ <br /> Storage Method &7(_1�. •t MATERIALS/DEVELOPMENT , <br /> Coniamination Noted ( y <br /> Storage Location Casing type <br /> BIank /„ ft. Screen /S ft. <br /> Slot size .D l <br /> CROUTING �' 'l Bags cement <br /> Buckets.bentonite 3K <br /> Depth to water �� Bag's sand/gravel -v�' _ <br /> -� �. w . ; ,vF9rer Pack Type/size <br /> Mix Ratios .. ," :� ;.� �,. �- L. S r •.� <br /> Installation Method r' Surge Bloclk: - n ) <br /> Quant ty Installed Discussed withgolo ist: - n'} <br /> Type of method <br /> ?2, <br />