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MO' ')RING WELL INSTALLATION REPORT <br /> N*.Wl <br /> Date: 5-2'7_'7 _3 ✓/ CONSTRUCTION <br /> Pre:rise Address: �TI�U �' �`�/✓ Total Depth 2-3 <br /> Screen Length (from) (to) / 3 <br /> Well No.: -� Filter Pack (from) Z –(to)� <br /> Bentonite (from) G (to) <br /> Insoec:or: Grout (from) (to) <br /> G3Drilling rig type <br /> Pennit No. !3 '�7�/ Auger O.D. I.D. <br /> �/ Completion- Stove pipe/chrstie box (circle one) <br /> Drlling Company. <br /> casing <br /> Dr11er. I -T height <br /> Consultant <br /> Geologist (lei1.962 A.3CV:-32ROC;N0 <br /> C'.:MP'�►ICN CNRtSY-3CX <br /> P:_=ICN <br /> Gmourd Stslaca <br /> SPECIAL. PE. UT INFO. <br /> flro(A <br /> Distance to sewer line N <br /> IA <br /> Domestic well on site - (y n) 9 tL <br /> I[yes, location and distance • l� -�' <br /> S��IPLING socson71VW pack <br /> x' <br /> Holding Temperature -Q- <br /> Me:hod —_ <br /> Screening Method <br /> Tracking Sheet On <br /> SPOILS J <br /> Storage Method MA i cR1ALS/DEVELOPIVtENT <br /> Contamination Noted - n) fie1. �v <br /> Storage Location Casing type <br /> -40 <br /> Blank /3 ft. Screen ft- <br /> Slot size D Z <br /> GROUTING Bags cement <br /> _ p Buckets bentonite r/y 3 P t 0-�� <br /> Depth to water O Bags sand/gravelS <br /> Mi.Y Ratios Filter Pack type/size <br /> Ins:alladon Merhod Surge Block: - (Y/0 <br /> Quantity Installed Discussed with geologist: - n) <br /> Type of method �-- <br />