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—,UTORING WELL INSTALLATION 1. .ORT 1I <br /> (h '(S lr3 CONS�ON <br /> Date: 2 / rs <br /> �d� v5ac� aa Total Depth j <br /> Premise Address: 866 Screen Length (from)' <br /> -zz Filter Park (from � <br /> ) (to) <br /> well No.: ' Bentonite' (from) z (to) 2.f <br /> Inspector: Grout (from) <br /> (to) <br /> Drillingrigtype CME 5r <br /> ¢ p Auger O.D. 97 c v0" I.D. Y <br /> Permit No. SR !�'+� b Completion- ve i Christie box (circle one) <br /> Drilling Company: LLJ 0 2 tl iw Q� <br /> S casing <br /> Domer. C . N o f' height <br /> Uw <br /> .•edY 1•rla•.� ���rrr d <br /> Consultant . <br /> Geologist � 1.BOVE-GROUND GHRISiY-BOX t <br /> CONPLEf1O4 COMPLETION <br /> 6rwrd Surfxe � , <br /> SPECIAL PERMIT INFO. grout I <br /> Distance to sewer line <br /> If yes, location and distance- _ft — <br /> — o <br /> SAMPLING aac9onr =_ <br /> �yypi yarJ( <br /> Holding Temperature ) <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> •r„Tg•rF;RIAISmEVELOPMENT <br /> Storage Method - t <br /> Contamination Noted- (y/n) Casing type S `GH O <br /> Storage Location Blank � Screen /D ft <br /> Slot$ize D 1 O <br /> Bags cement 2 <br /> GROITIING Buckets bentonite <br /> Bags sand/gravel 2A #z /Z <br /> Depth to water Filter Packtype/s' <br /> Mix Ratios _ .3yrge Wock:_C.y-&Z <br /> Installation Method Discussed with geologist: - C y/ n) <br /> Quantity Installed . Type of method <br /> EH 29 29 ; <br />