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�h*UONITOMW WK.L.INSTALLATION REI h <br /> Date: z rOUON, <br /> ,-. <br /> Premise Address:_ Tata!Depth ` <br /> /L Screen Length(from) (to) <br /> Well No.: filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. Grout (from) <br /> _ G� Drilling rig type <br /> Permit No. Auger O.D. Y , <br /> Completion-Stove pi ' tie box circle one) <br /> Drilling Company: <br /> Driller: casing <br /> Consultant �?'l r <br /> T height <br /> Geologist y ... �' <br /> ABOVE-GROUND , <br /> COMPLETION <br /> COMPf.UION <br /> GeouadSuHace <br /> Dieu tnee to sewer line <br /> Domestic w0l on site-,(y n) 14= • B. <br /> If yes,location and distance- <br /> r <br /> swrlen � = <br /> Holding Temperature r = <br /> Method Pa* <br /> Screenings Method <br /> Tracking Sheet - (y n} _� <br /> Storage Method �itA�ERIAIS/DEWLOPWM <br /> Contamination Noted• (y/n) <br /> Storage Locadon Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROLMNG Bags cement <br /> t Buckets bentonite. <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/n) <br /> Quantity Installed Discussed with geologist: - (y/n} <br /> Type of method <br /> EH 2.9 29 <br />