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AIA1041TORING WELL REPOR:%O e <br /> Date: 157 CONSTRUCTION <br /> Premise Address: f"• � 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/cluistie box (circle one) <br /> Drilling Company- <br /> Driller: oas inq <br /> height <br /> Consultant J -_ <br /> Geologist L -- <br /> ABOVE-GROUND CHA TY43OX <br /> COWLETION COM>'Lnw <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> grout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - tL <br /> Y' d <br /> SAMPLING <br /> Holding Temperature <br /> Method — P-04k <br /> Screening Method ' <br /> Tracking Sheet - ( y/ n ) .;�A — <br /> — <br /> ......�.....tt. M <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n } <br /> Storage Location Casing type <br /> Blank h. Screen h. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />