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'% a TORING WELL INSTALLATION REPta.. <br /> Date: `-fi " ��� _ CONSTRUCTION <br /> P <br /> Premise Address: . Iry Total Depth <br /> lJ Screen Length (from) -5 (to) <br /> Well No.: LA) Filter Pack (from) (to) <br /> Bentonite (from) t0 (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. <br /> 92 ' 0 5-7f Auger O.D. I.D. � <br /> Completion - Cove pipe/cluistie box (circle one) <br /> Drilling Company: 4m—k <br /> Driller: oaai.ng <br /> height <br /> Consultant <br /> Geologist �ii' P/+�_ <br /> ABCVE-GRCUND CtiA1M43OX <br /> COWI.E-TlCN COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Suiace <br /> Distance to sewer line <br /> Domestic well on site - (y/n) <br /> If yes, Iocation and distance - ft- <br /> �tt. <br /> SAMPLING slorad 4 <br /> sadcn M <br /> Holding Temperature <br /> Method r �� <br /> Screening Method — <br /> Tracking Sheet - {y/ n ) — <br /> a..._.....�tt. .,,.,..... r IL <br /> SPOILS <br /> Storage Method �p�- ED% 2j MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/n ) -ter R—a-, <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> SIot size <br /> GROUTTNG Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios 7 . �-MA-I- _S�{,becy, f�s 5 Filter Pack type/size <br /> Installation Method- R n p Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />