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►; fiTOpING w LL INSTALLATION REPOIt <br /> Date: <br /> D- 1q3 ' Io-r�-y3 /®—r3- � l0� q3 CONS RLUCr0 N Well No.: � <br /> � , <br /> Total, <br /> Premise Address: Total th <br /> Dep , <br /> Screen Length (from) 15 (to) 5 <br /> i.. Well No.: ,+vW(l Z Filter Pack= (from) Cto} <br /> Bentonite (from) (to),_„S <br /> Inspector. ' Grout (froth) S (to) t� <br /> may, C Drilling rig type <br /> Permit No. / J Auger 0 8 I.D. �o <br /> Completion -Stove pip ae box (circle one) <br /> O <br /> Driilirg Company: <br />} Driller. D CONS1RU01ON Well No.: <br />! n <br /> Consultant Total Depth� X (to} 5 <br /> Screen Length (from), <br /> FilteGeologist ' Bent irek (from) 1m� .' _ (t) <br /> Bentonite (from) <br /> Grout (from) (to),�^� <br /> SPECIAL _RMIT INFO. Drilling rig We i <br /> Auger O.D <br /> Completion - Stove i e/christie box {circle one) <br /> Distance to seti Zine P p p <br /> w <br /> Domestic well on si - C / n) <br /> If yes, location and dis ce - r ' <br /> CONSTRUCTION Well No.: <br /> Total Depth - <br /> jJ6 Screen Length (from) (to) <br /> SAMPUNG Filter Pack. Cfroat) <br /> (to) p <br /> �( Bentonite (from) <br /> Grout (from) ,��� --(to) C� <br /> ;} I-inlding Temperature- 6&w- - 94-1��2 Drilling rig type <br /> r, 1 Method <br /> Sc.,ieninv Method Auger O.D. I.D. <br /> Tracking Sheet - n) Completion-Stove pipe/carisde box (circle one) <br /> i SPOILS q, _ <br /> 1 I <br /> Storage Method. 6Yt <br /> I' U"_JeA MATERf;4IS/DEVEi•OPMENT <br /> Contamination Noted - C y n /I <br /> ' Storage Location Oh 8 type <br /> Casin <br /> �. <br /> Blank. - (o 15 ft- Screen Z o _fr. <br /> - Slot size . 01 <br /> GROUTING .. Bags semen[ <br /> i Buckets bcntonice <br /> Depth to water (o 2- 76 -- Bags sand/gravel <br /> Mix Ratios Filter Pack typesize 2— <br /> ' installation Method Surge Block: - C y/ a ) <br /> �uancity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> '129 29 <br /> 4 <br /> 10-/1-23 <br />