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�,�r"4l';IIT«RING WELL.INSTALLATION REPbt <br /> r.- <br /> t # <br /> Date:: caNSTRUQr <br /> Premise Address: I/[) Total Depth <br /> Screen Length (from) (to) <br /> Well No.. V Filter Pack (from) tto) <br /> --�–� Bentonite (from) (to) <br /> Inspector: I+ ir' V..z W--C-- z Groat (From) 00)� <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> crjCompletion -Stove pipe/clu'is[ie box:. (circle cine) <br /> Drilling Company; tr�� » ,�cL <br /> k <br /> Driller:- F—V't,( Eoff&zojL& casing <br /> IT he light <br /> Consultant <br /> Geologist- <br /> S... � t�r nom: t t7� V <br /> AW G-�3�3�nVs D V�'ZW-BOX .:. <br /> SPECIAL PERMIT INFO. Ground Szrrfact <br /> Distance to sewer line !"Ak gout <br /> Domestic well on site - (y// n__ — I#a <br /> If yes, location and distance- <br /> ��e� mit. <br /> SAMPLING ``r``�' <br /> alcrad v � <br /> meson k _ <br /> Holding Temperature VW4A ,Q Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) ; <br /> ft. tt. <br /> BPOILS <br /> Storage Method ;, t�V L Tc MATER. AI S/DI VEI,OPMENT <br /> Contamination Noted= /n) a* <br /> Storage Location Casing type <br /> Blank ft Screen ft <br /> Slot size <br /> GRQjMNG Bags cement <br /> t Buckets bentonite <br /> Depth to water l � Bags sand/gravel <br /> Mix Ratios -� ' Filter Pack type/size <br /> Installation Method Surge Black: - (y/n) <br /> Quantity Installed Discussed with geologist. - (y/n <br /> Type of method <br /> EH 29 29 <br />