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kw ONITOILIxG WF•LL DWAUATION REPS. <br /> Dam. q2, Z N <br /> Premise Address: 152-5 Total Depth <br /> Screen Length (from) (m) 1 <br /> Well No.: Mw 3 A Filter Pack (from) 2 (to}� <br /> Bentonite (from) L <br /> Inspector. M fit+- S Grout (from) dr Y1, <br /> Drilling rig type <br /> Permit No. 921- b5�' Auger O.D. I.U. <br /> Completion-Stove pi �t circle one) <br /> Drilling Company:,,,,,,,5Wy�YJrn _�__-___ <br /> Driller: casing <br /> height <br /> Consultant T. <br /> Geologist <br /> 1LllOVE•GACUND q.PMy-80X <br /> COt4PL.ETION MN <br /> SPECIAL FERMI'i'INFO. Cironnd&slow <br /> Distance to sewer line WVA <br /> Domestic well on site - (y <br /> If yes,location and distance <br /> rlored <br /> ssccn <br /> Holding TemperaturePack <br /> .N <br /> Method... 1{,e /1&"a:zar <br /> Screening Meth6dd^P1-0. <br /> Tracking Sheet - (y/n <br /> SAS <br /> Storage Method4IM MATERIA!"EVELOpMENT <br /> Contamination Noted - W n) <br /> &MV Location 6t Casing type_ <br /> Blank 15 ft. Screen 10 ft. <br /> Slot she • 07-Z) <br /> GROUTING Bags cement <br /> e n t X1811 Buckets bentonite <br /> Depth to water 3��,-„ 01cmmnid Bags sand/gravel <br /> Mix Ratios Filter Pack typeMY ;).L a iz . . <br /> Installation Method Surge Block: - <br /> Quantity Installed Discussed with geologist: &CL n) <br /> Type of method 2'� <br /> EH 2.9 29 <br />