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NIQULTa iL INSTALLATION REPORT <br /> Date: 1111 17 CONSTRUCTION <br /> Premise Address: 76� Total Depth �S <br /> ``-- n / / Screen Length (from) (to) <br /> Well No.: f3tG 'toy Nu •r/ Mkt Filter Pack (from) (to) <br /> p ' Bentonite (from) (to) <br /> Inspector: Grout (from) (to)� <br /> �2,Uo�OZ Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> �S1 Completion- Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casi. g <br /> / � j hei9ri't <br /> Consultant <br /> Geologist �G-Pi ABOVE-G pUND <br /> COMP ION CHR13T 4= <br /> ` COMPLETION <br /> SPECIAL PERMIT INFO.(M /�l� Ground Swfxs <br /> Distance to sewer line grout <br /> Domestic well on site - (y On 7i n, <br /> If yes, location and distance - g, <br /> ft. <br /> vF O <br /> w( C <br /> SAMPLING slattod c <br /> sac9on �- = B <br /> Holding Tem erature <br /> Method <br /> Screening Method <br /> Tracking Sheet - /n) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y( / <br /> Storage Location. - i Casing type <br /> BI f}! Screen fr. <br /> Slot s e / <br /> GROUTING Bags ce e <br /> Buckets b tonit <br /> Depth to water �/DD Bags sand/' v <br /> Mix Ratios ^- Filter Pack /size <br /> Installation Method Surge Block: Veolo Quantity Installed Discussed thgist: - (y/ n ) <br /> Type of m o <br /> EH 29 29 <br />