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I TOPING WELL INSTALLATION IRPRTO <br /> Date: CONSTRUCTION <br /> Premise Address: SSD E Kai Total Depth 70 <br /> Well No.: 01, i,'icr Screen LeFilter Pack (from) (to) <br /> (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/christie box (circle one) <br /> Drilling Company: Ln ,c, .< <br /> Driller: casing <br /> height <br /> Consultant l,/✓Z <br /> Geologist �l <br /> ABOVE-GROUND <br /> COMPLETION CNA STY 80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. GroundC%– Surface <br /> Distance to sewer line 0ry-, <br /> Domestic well on site - ( y/ n) ft <br /> If yes, location and distance - <br /> ft. <br /> = e <br /> SAMPLING dctlad _ 8 <br /> wc4cn — <br /> Holding Temperature <br /> Method = gravel Pack <br /> Screening Method <br /> Tracking Sheet - (y/n ) ` — <br /> tt. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water aA. 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 />