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TORING WELL INSTALLATIOI� <br /> i <br /> Date: CONSTRUCTION <br /> o <br /> Premise Address:n Z Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (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:�wL r!yr <br /> Driller: casing <br /> U��Consultant height T <br /> Geologist T— V T <br /> ABOVE-GROUND <br /> COMPLETION CHMM-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground g yy <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n) n <br /> If yes, location and distance - <br /> n n. <br /> _ e <br /> SAMPLING ' _ <br /> slored = <br /> 846c5on x: _ <br /> Holding Temperature <br /> Method ' —_ 72vW pack <br /> Screening Method <br /> Tracking Sheet - (y/ n ) , _ <br /> — _n. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n) P r <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/ n) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />