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ji„,IMTORING WELL INSTALLATION REPORy <br /> Date: -7• 3 "" " 0 A ) CONSTRUCTION <br /> Premise Address: pI � tTotal Depth 25 <br /> Screen Length (from) (to) Z_ <br /> Well No.: M W Filter Pack (from) 7 b (to)� <br /> Bentonite (from) (D '/2 (to) 51/2- <br /> Inspector. ! Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pip saeboz le one) <br /> Drilling Company: SP PG'1YJrYl <br /> Driller: �obli l -Ll ,I12✓ F177 <br /> -#f- <br /> . casing <br /> V/ , � height <br /> Consultant ) V -EWT <br /> - <br /> Geologist �b✓� �V` ��� AgpyE-GACUND <br /> ` CCX <br /> MW4 CC#APLEnCN <br /> S� YSPECIAL PERMIT INFO. emw(w'eAr <br /> 5 O 4 grout <br /> Distance to sewer line �� 12� <br /> Domestic well on site - (y n I2yz 88 SlZ- ft. <br /> If yes, location and distance - 15' 6 ( (,Ym tL <br /> 20` D <br /> V9 U <br /> 2Y C) = <br /> _ <br /> o <br /> SAMPLING abnad = 3 <br /> aocicn _ <br /> Holding Temperature a CUr()� = gravel pads <br /> Method I t_y <br /> Screening Method VID <br /> Tracking Sheet - n ) <br /> SPOILS <br /> Storage Method L.Y� d: 1A� MATERIALS/DEVELOPMENT <br /> Contamination Noted(n)p/ n ) 2 y -P <br /> Storage Location fart 15;L 4-e Casing VIRe <br /> Blank--'6-ft. Screen <br /> Slot size O <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to war Bags sand/gravel <br /> Mix Rados 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 />