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UTORING WELL INSTALLATION REF <br /> Date:., 6�7i��1 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) 33 (to) Z3 <br /> Well No.: Filter Pack (from) 33 (to) 2b•8 <br /> Bentonite (from) ?/'•t3 (to) 17 S <br /> Inspector: Gabe-41 G04741C t . Grout (from) s-Af-kce (to) 11. 8 <br /> Drilling rig type <br /> Permit No. OA-7A.6 43 Auger O.D. ZI.D. <br /> Drilling Company:_ I,Jod(��'u/� Dr �`I�►r Completione/cluistie box (circle one) <br /> y <br /> Driller:_ 5ef 16 670/(y ,��^efo casing <br /> � <br /> height: <br /> Consultant !`� 3kJ• � <br /> Geologist_ LP5<11f <br /> ABOVE-GRCUND CNAISTY-BOX <br /> CONFLETCN COMPtET1CN <br /> SPECIAL PERMIT INFO. Ground Surfaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) � ft. <br /> If yes, location and distance - ff. <br /> ft. <br /> 0 <br /> SAMPLING 71h, 56"" '` _ � <br /> prvd y, — c <br /> el <br /> 44e cn <br /> Holding Temperature_ y <br /> Method _TCtv WW <br /> Screening Method "c> <br /> Tracking Sheet - ( y/ n ) <br /> tto <br /> SPOILS <br /> Storage Method ST �A MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) vL ;e-17y D <br /> Storage Location aft4f�t Casing type_ <br /> Blank a3 Screen ft. <br /> Slot size p2 ko— <br /> GROUTING Bags cement_ <br /> Buckets bentonite 1-1- &.y5 <br /> Depth to water ro r 7 1 Bags sand/gravel y &*Af <br /> Mix Ratios A.1,g j f- 97/A. Filter Pack type/size___ ir <br /> Installation Method 40#^ jptMe Surge Block: - ( y/1P) <br /> Quantity InstalledDiscussed with geologist: - (bv/ n ) <br /> Type of method <br /> EH 29 29 <br />