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tO1WNITOPJNG WELL INSTALLATION REPOR'f-O" <br /> Date: CONSTRUCTION <br /> Premise Address: Tot e-pth �lq <br /> Screen Length (from) A19 (to) 2 <br /> Well No.: ( LA Filter Pack (from) 4 q (to) z <br /> Bentonite (from) h- (to) •-' <br /> Inspector: Grout (from) •� (to) o <br /> Drilling rig type <br /> Permit No. 9 3 -(A Z-JIP Auger O.D._/- I.D. <br /> Drilling Comp <br /> Completion- Stove pipe/clzristie box (circle one) <br /> "an�y:( ,,,�- ,�(� <br /> Driller: t6,t,— casing <br /> height <br /> Consultant -EWT <br /> Geologis <br /> ABCVE-GRC4JND CHS TM-SOX <br /> COMPLETION COMPLEMCN <br /> SPECIAL PERMIT INFO. Ground Surfaca <br /> Distance to sewer line grout <br /> Domestic well on site - (y <br /> If yes, location and distance - K <br /> ft. <br /> SAMPLING <br /> �1 ilara.i 5. � <br /> so4lcn <br /> Holding Temperature grlyw <br /> Method — r <br /> Screening Method _ <br /> Tracking Sheet - ( y/ n ) <br /> SPOILS <br /> Storage Method O),- MATERIALS/DEVELOPMENT C,�N X12 C <br /> Contamination Noted - ( �U� i, b„ <br /> Storage Location &L Casing type <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement 1 <br /> Buckets bentonite <br /> Depth to water m IAM– _ Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - G/ ii ) <br /> Quantity Installed Discussed with geol gist: - ( y/ n ) <br /> Type of metliod <br /> EH 29 29 <br />