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1 b � <br /> MOORING WELL INSTALLATION REPORT <br /> 0 s r•z y}ro`M <br /> - I ("Illy; o•..,e <br /> ro. Z5' <br /> Date:_ CONSTRUCTION � rl <br /> dwM29.J <br /> Premise Address: <br /> agtg9f Total Depthl�� 'r=(l <br /> (to) <br /> Inspector. VJ 0 t (a B —(tom) (to) <br /> Grout (from) (to) <br /> Drilling rig type dine�Dr=, <br /> Permit No. Auger O.D. -Z " I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company. LA <br /> -Pro�J <br /> Driller: e A A-.-s �tiv-t S cas nq (�r'nou3 <br /> �jw4 � -ght Coi-ed <br /> Consultant C ( 'd <br /> Geologist U t C-('0 ria, (,G \ <br /> i1 jWLNOND G <br /> OMPLETIC <br /> SPECIAL PERMIT INFO. ~K -�Ground Stalaet <br /> Distance to sewer line S3-2 grout <br /> Domestic well on site - (y/P ) <br /> If yes, location and distance `� S: n• �o'J 5�� <br /> SAMPLING 1 �} Clay �lorai = S S 67� <br /> sacien _ <br /> Holding Temperature = 9r" pack Zq-!*q <br /> Method - Ee tk) <br /> Screening Method > > Y *2 Chi <br /> Tracking Sheet - (y/ n ) ! 6k �,.,p y�(�� _ Pock. <br /> G <br /> �• k bow S�� <br /> SPOILS <br /> i <br /> Storage Method / U 5 p(/(S �tS �3 /, ; MATERIALS/DEVELOPMENT 23 'bs <br /> Contamination Noted - (y/n) <br /> Storage Location ft. -S4te09s— <br /> ft. <br /> IH;TiIYr�ZQ � D <br /> �X,X.�/C/ c� per- C t aags ecsne!!t✓ Fh� <br /> GROUTING(ZF1' bore rb�le Win` r <br /> SF I C 1, \ 5�' r ;,LQo1Cer _ <br /> �l �• <br /> Depth tow er a �' A6 D <br /> Mix Ratios er /b <br /> Installation Method '' h FS (y/ n ) <br /> Quantity Installed a odtr, = ( / n ) - <br /> Type of method - <br /> EH 29 29 - y <br /> U � � 1,J',rN/ /n.!•-� � Ltrt�(7eC.L'i7�' C .� W <br /> oo C9 <br />