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MV...rORING WELL INSTALLATION REPORT <br /> Date: IO Un_q L ^ CONSTRUCTION <br /> Premise Address: 60� 4 11 Total Depth 2(0. T{'t <br /> Screen Length (from) Z( (to) Z 3.5 <br /> Well No.: N Filter Pack (from) 23. (to) Z'-')I <br /> 'L . Bentonite (from) 2Z. 11 (to) 19.9 <br /> Inspector: Grout (from) 19.9 (to) f i <br /> Drilling rig type 55 <br /> Permit No. Z 38 Auger O.D. 6" I.D. <br /> Completion - Stove pipe/ a ox (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant Ci IV <br /> _qV <br /> Geologist •- <br /> e18OVE-GRCUND CHAtSTY-3OX <br /> COM?L"�'T{ON COMPI,EnCN <br /> SPECIAL PERMIT INFO. I I, Ground Surtxs <br /> Distance to sewer line rn grout <br /> Domestic well on site - (y/ n�) <br /> If yes, location and distance - ft. <br /> = m <br /> - C <br /> SAMPLING <br /> Holding Temperaturegnvw= F <br /> ack <br /> Method I Zs. — <br /> Screening Method ^c <br /> Tracking Sheet - ( y/ n ) — <br /> ;Y. <br /> SPOILS <br /> Storage Method aal _ MATERIALS/DEVELOPMENT <br /> Contamination Note - ( y/ n�/ , <br /> Storage Location V�5 CL Casing type <br /> Blank ZD ft. Screen 3• ft. <br /> Slot size .01 <br /> GROUTING Bags cement_jjl <br /> Buckets bentonite s s <br /> Depth to water Bags sand/gravel <br /> Mix Ratios --� Fj Filter Pack type/sized V4 <br /> Installation Method r10n��x2S� __ Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 <br />