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Mor"RKORING WELL INSTALLATION REPORT <br /> Date: 7���U'i7 _ CONSTRUCTION <br /> Premise Address:_ 11?1 Total Depth �D <br /> Screen Length (from) 3 0' (to) /cam' <br /> Well No.: 192 Gehl Filter Pack (from) v' (to) 91- <br /> Bentonite <br /> 1Bentonite (froth)_ k' ' _(to) 7' <br /> Inspector•. C`' Grout (from) 7 ' (to -- — <br /> Drilling rig type l <br /> Permit No. Auger O.D. <br /> amu.A-' � Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: – c - casing <br /> height <br /> Consultant <br /> Geologist -,mac— `~ <br /> ABCVE-GF1CVND G SlS7Y-34X <br /> OC WL.ETC N cc#APL--ncN <br /> SPECIAL PERMIT INFO. Ground Satacs <br /> Distance to sewer lineG <br /> U <br /> _ prait <br /> Domestic well on site ( y/ n ) <br /> If yes, location and distance - I}, <br /> • ft. <br /> _ a <br /> G <br /> 4 <br /> SAMPLING ■lor�.i �; be <br /> M ~ ]C <br /> sQGJcn NNN <br /> Holding Temperature�� _ <br /> Method = F <br /> Screening Method � •_ _ ___- <br /> Tracking Sheet - (m/ n ) <br /> n. <br /> SPOILS <br /> Storage Method e K p MATERJALSMEVELOPMENT_ <br /> Contamination Noted n ) 0�0 <br /> Storage Location d,. a-ci _ Casing type a P✓G Blank--_412 ft. Screen fr. <br /> Slot size . 00)-c <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth water a Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size �•/1�. <br /> Installation Method Surge Block: - (� n } <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> EH 29 29 Type of method <br />