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MG,..PORING WELL INSTALLATION REPORT <br /> Date: I fl' U/"7!i CONSTRUCTION <br /> Premise Address: Total Depth <br /> I'1�a Screen Length (from) 1 (to) IZ. <br /> Well No.: W -1 Filter Pack (from) (to) h ? <br /> II Bentonite (from) (to) 9- <br /> Inspector: Grout (from) 9.,57 (to) <br /> � Drilling rig type `�3 <br /> Permit No. V' 3 8 38 Auger O.D. lb" I.D. <br /> Completion - Stove pi Christie box ' cle one) <br /> Drilling Company: 6 f <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist •- <br /> /IBOVE-GACUND C iRZTY-80X <br /> CONFU°TION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface T <br /> Distance to sewer line Grout <br /> Domestic well on site - ( y On <br /> If yes, location and distance - ft <br /> ft.. <br /> it. <br /> = m <br /> - C <br /> SAMPLING glorA = c <br /> secticn =_ <br /> Holding Temperature k = gnvw pack <br /> Method = <br /> Screening Method c __ <br /> Tracking Sheet - ( y/ n ) — <br /> �fi. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Note - ( / n ) KU)1- I fy­ <br /> Storage LocationCasing type Pyc' <br /> Blank-- Z- ft. Screen ft. <br /> Slot size t <br /> GROUTING Bags cement o AW <br /> Buckets bentonite 2 ba -;-j <br /> Depth to water I Bag��gravel. <br /> Mix Ratios _ FUteYPack type/size 0 <br /> Installation Method Surge Block: - (Q/ Il } <br /> Quantity Installed Discussed with geclo 'st: - (�y/ n ) <br /> Type of method LAA 16, It <br /> EH 29 29 <br />