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MOTORING WELL INSTALLATION Ire <br /> Date: I(I 6S CONSTRUCTION <br /> Premise Address: d�b Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from)—(to)- <br /> Inspector: <br /> from) (to)Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: 6", <br /> Completion - Stove pipe/christie box (circle one) <br /> Driller: ^ v casing <br /> Consultant height!�v/ <br /> Geologist 1 — <br /> ABOVE-GROUND <br /> T <br /> COMPLETION CHRISTY4= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line of0 n <br /> Domestic well on site - ( y/ n) ft <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> SAMPLING ✓/74 slotted = B <br /> sarJon -el <br /> Holding Temperature <br /> Method _ <br /> Screening Method <br /> Tracking Sheet - (y/ n ) a <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n ) r/ <br /> Storage Location Casing type � 76 PIVD <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water C to 3 b ( 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 />