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WELL INSTALLATION REPO <br /> Date: Ifl-I -°I4 CONSTRUCTION <br /> Premise Address: 452o S. trtil t qq Total Depth 30 <br /> Screen Length (from) 0 (to) Z 5 <br /> Well No.: PVI' W&Filter Pack (from) 30 (to) <br /> Bentonite (fro (to) <br /> Inspector: eM°zsS1ti Grout (fr ) (to) <br /> Drilling rig typ <br /> Permit No. Auger O.D. I.D. <br /> Completio - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant 6 imA Di,,At, _qV7F <br /> Geologist <br /> ABOVE-GACUND CI-iA1M43OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface �•— <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING slored <br /> aadcn <br /> Holding Temperature9MV1W Pack <br /> N <br /> Method _ <br /> A <br /> _ <br /> Screening Method <br /> �v = <br /> Tracking Sheet - (y/n ) _ <br /> .a: <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Notedy/n) 11 <br /> - <br /> Storage Location Casing type 2 <br /> Blank ft. Screen 6, ft. <br /> Slot size .oZ <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/sizee BAca�_ <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />