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MOhi'ORING WELL INSTALLATION REPORT <br /> Date: 2' Q Z CONSTRUCTION <br /> Premise Address: - Total Depth 1 <br /> Screen Length (fror4) '-51! (to} L6 E <br /> Well No.: 6N10 W Filter Pack (from) S1 ' (to) -&Z ____ <br /> Bentonite (from) Z ' (to) za <br /> Inspector: C : Grout (from) LID —(to) O' <br /> Drilling rig type <br /> Permit No. Auger O.D. tl <br /> LD <br /> Completion - Stove pi christie (circle one) <br /> Drilling Company: <br /> Driller: f casing <br /> height <br /> Consultant_ f]T <br /> Geologist <br /> 11 <br /> ABOVE-GACUND CNfit.SfY-BOX <br /> COMPt.EfION COMPLETION <br /> SPECIAL PERMIT INFO. - Gmurd Surfacw <br /> Distance to sewer line Qfout <br /> Domestic well on site - (y/6) ,�.� ;_ft. <br /> If yes, location and distance - <br /> �. ft. <br /> OA tl <br /> Q <br /> SAMPLING 'F In slorwi <br /> 5� q� socdcn — <br /> Holding Temperature 'N = <br /> Method _ lam ' = Rs Pack <br /> Screening Method <br /> Tracking Shcet <br /> SPOILS o <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - / n) n C Y it <br /> Storage Location Casing type t' <br /> Blank 2.4 fL Screen Z-�- ft. <br /> Slot size <br /> GROU'T'ING cement <br /> bentonite <br /> Depth to eater Bags sand/gravel - 8"- 46 <br /> Mix Ratios =R qokln Filter Pack type/size <br /> Installation Method Surge Block: - (y it <br /> Quantity Installed - Discussed with geologist: - O n) <br /> Type of method <br /> EH 29 29 r .. <br />