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. NITOPJNG WELL INSTALLATION RE* <br /> Date: CONSTRUCTION <br /> Premise Address: ?.46 �Oo Total Depth �Z•s'��'' <br /> Screen Length (from) IZ.S' (to) 7.5-' <br /> Well No.: �II=�� _ Filter Pack (from) (to) S <br /> Bentonite (from) S- f (to) 2- ' <br /> Inspector: C70J. 'C6anZA Ie, Grout (from) su A (to) 2 � <br /> Drilling rig type Qk;g I <br /> Permit No. 5 j?0 D 43 Auger O.D. » I.D. gI 2-5- <br /> Completion - rove pi cluistie box (circle one) <br /> Drilling Company: 1JO0AWe-4 <br /> Driller: k AW neeJrbl-+ lD t'Zt/ 14 casing <br /> he?ght: <br /> Consultant �RS <br /> Geologist L ,Sl Alelw .^ <br /> ABOVE-GACUND C4gR*TY4= <br /> CO MPL.ETC N COMPLEMCN <br /> SPECIAL PERMIT INFO. G=nd Surface --� <br /> Distance to sever line grout <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft- <br /> ft. <br /> — m <br /> SAMPLING �tS j,Sb" $lor:v� <br /> tacicn =_ <br /> Holding Temperature — PaCR <br /> Method TL(, (odI <br /> Screening Method <br /> Tracking Sheet ( y/ n ) <br /> ft. E fE. <br /> SPOILS <br /> Storage Method s g Nl O VM MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y�1t ) J� <br /> Storage Location f7mt Casing type C <br /> Blank 4-3' �,°> a Screen ft. <br /> Slot size <br /> GROUTING Bags cement_) Z 541ru( <br /> • Buckets bentonite I-t-bAh5 5V)6, Orr¢�s <br /> Depth to water Bags sand/gravel _ba�S <br /> Mix Ratios ,�p*, mob 17/,6b� Filter Pack type/size <br /> Installation Method bIEI � Surge Block: - ( y/(5) -- <br /> Quantity Installed Discussed witha (6/ n ) <br /> Type of method — <br /> EH 29 29 <br />