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lWING WELL INSTALLATION R.,��/ <br /> Dat,::: CONSTRUCTION <br /> Premise Address: _ Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: _ _ Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist _ -• T <br /> ABOVE-GROUND <br /> COWPLET;CN C 4R*TY-BOX <br /> COMPLEnCN <br /> SPECIAL PERMIT INFO. <br /> Ground Surfac. <br /> Distance to sewer line _ arm <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ft. <br /> -- s.ft. <br /> - C <br /> SAMPLING <br /> a•scicn <br /> Holding Temperature __ F <br /> Method <br /> Screening Method m_ <br /> Tracking Sheet (y/ n ) " = <br /> SPOILS <br /> Storage Method _ MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft, <br /> Slot size _ <br /> GROUTING Bags cements !-^ <br /> Buckets bentonite_ <br /> Depth to water Bags sand/gravel ___ _ <br /> Mix Ratios Filter Pack type/size _ <br /> Installation Method Surge Block: - ( y <br /> Quantity Installed _ Discussed with geologist: - ( y/ n ) <br /> EH 29 29 <br /> Type of method <br /> — -- - <br />