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UNITORING WELL INSTALLATION REPO.,, <br /> Date: �1/��/�� CONSTRUCTION <br /> Premise Address: �D.fL� or�/f�9✓1 Total Depth V <br /> Screen Length (from) �b (to) Zd <br /> Well No.: // 1�� Filter Pack (from) -YO (to) /8 <br /> (to)9FF <br /> Inspector. ���NS Grout (from) <br /> Bentonite (from) /8 (to) V-1 <br /> P 5 IS' kr�me <br /> Drilling rig <br /> Permit No. Auger O.D. ISL: d <br /> ��� Completion -Stove pipe uisde bm (circle one) <br /> Drilling Company,.-- /A P� x <br /> Driller: 1/(Pj ✓7F-y- casing <br /> height <br /> Consultant �.�� �19oc" .4411 <br /> Geologist i"//r& <br /> ABOVE-GRCUND CHRISTY 80X <br /> CONPLETION ON <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> Distance to sewer line Omit <br /> Domestic well on site - (y/n) , fte <br /> If yes, location and distance - <br /> o27D {t tL <br /> Y+. <br /> . � G <br /> SAMPLING storedsecdcn <br /> _ <br /> yM <br /> Holding Tempera a <br /> vat <br /> Method <br /> Screening Method <br /> Tracking Sheet - &Y n ) <br /> SPOILS <br /> Storage Method od o ' Ac MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y 4n) y6 PVG <br /> Storage Location Casing type <br /> Blank Zd ft. Screen 7_0 ft. <br /> Slot size ozo <br /> GROUTING Bags cement_ TR� <br /> Buckets bentonite <br /> Depth to waterD Bags sand/gravel 3 Nel�f <br /> MixRatios �eiM 4— Filter Pack type/size <br /> InstallationM6thod Ta w,�— Surge Block: - ( y/ n3 <br /> Quantity Installed Discussed with geo ogist•. - y/ n) <br /> Type of method <br /> EH 29 29 <br />