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r <br /> MQ PORING WELL INSTALLATION REPORT " <br /> t <br /> Date: �5 Z CONSTRUCTION —V S <br /> Premise Address: '� Total Depth <br /> V Screen Length Urom)�1 (to) 1 , <br /> WeII No.: V w 4f� H EJ$- Filter Pack (from) < < (to) <br /> k ! Bentonite (fro <br /> r. (to) l <br /> Inspector: C Grout (from) l (to)•_ f� <br /> n Drilling rig type <br /> Permit No,—V- 0.31 Auger O.D. � <br /> Completion - Stove pi clu�istie box cle one) <br /> Drilling Co any: LA Q <br /> Driller: casing <br /> Consultant <br /> Geologist - M r <br /> I480vE-GFtL`UNT] CXRZ Y-SOX <br /> 0OWL.EfION CGMPLEnON <br /> SPECIAL PERMIT INFO. - Ground Surface �^+ '�° <br /> Distance to sewer line 4 K/Zgrout <br /> Domestic well on site - (y/tC �_�__,__��' <br /> If yes, location and distance - ft- <br /> SAMPLING <br /> Holding Temperature _ ,N <br /> Method V-1-1 "' "" aif 9�pack <br /> Screening Method__ t P l l }" <br /> Tracking Sheet - (y/ n } <br /> SPOILS — QKq , . . ..... <br /> Storage Method bX, &tt - k, 4k k4U1 MATERIALS/DEVELOPMENT - V{�S <br /> Contamination Noted - n <br /> Storage Location Casing type A " C <br /> Blank ft. creep ft. <br /> Slot size <br /> GROUTING - age cement . <br /> bentonite -11;11 . <br /> Depth to water AJA �`. . Bags sand/gravel <br /> Mix Ratios _ Filter Pack type/size <br /> Installation Method Surge Block: - (y/ )) <br /> Quantity Installed = Discussed with geologist: - n ) <br /> Type of method <br /> EH 29 29 <br />