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WELL INSTALLATION REPG,,.,, <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth 64 <br /> Screen Length (from) to 4- (to) 3 J. <br /> Well No.: Filter Pack (from) (p4 (to) -3�.5 <br /> I(, Bentonite (from) 3�•5 (to) 3D,1 <br /> Inspector: 6rettt�t�tQ(from) 3�•5 (to) <br /> Drilling ng type ON 85 <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe irtsae o (circle one) <br /> Drilling Company: <br /> Driller: 6144, casing <br /> Consultant height <br /> _EWT <br /> n <br /> Geologist 66kk -- <br /> AiO0 -GRCUND CHSZTY43OX <br /> COMPLETION C WUOt_= ICN <br /> SPECIAL PERMIT INFO. Ground Scutari •� <br /> Distance to sewer line grout <br /> Domestic well on site - y n ) <br /> If yes, location and dis e - <br /> n• <br /> n. <br /> SAMPLING .loro.i — <br /> .M <br /> sodcn <br /> Holding Temperature <br /> Method "' = IxsvW Pack <br /> Screening Method I� <br /> Tracking Sheet - (y/ n ) <br /> .a: <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - y n ) � <br /> Storage Location Casing type <br /> Blank 3 ft. Screen ---�O ft. <br /> Slot size (16 2 O <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel 2-1 1 Z <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/n <br /> Quantity Installed Discussed with geologist: - (y <br /> Type of method <br /> EH 29 29 <br />