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1btQI RING WELL,INS'T'ALLATION REPORT r <br /> ;tL 6q1D { CON U ON Well,No.< <br /> LW I <br /> ,. .� Tota! Depth <br /> Premise Address:_ (to) <br /> - Screen Length {from) <br /> Well No.: ?t� VW S. �� � Filter Pack (from)� (to)Et <br /> � <br /> Bentonite (from)..__ (to) <br /> Inspector- Grout (frcmj_. ,too) O <br /> — <br /> Drilling rig type <br /> Permit No. ' Auger O.D. <br /> Completion -Stove pip tie box (cit a cine) <br /> Drilling Company: w ; <br /> S)riller. <br /> CO_MUS Well No.; 1b L_ <br /> ...-- � <br /> Total Depth_ <br /> Consultant Screen Length (from) ,__,(to) <br /> - Fuer Pact (from} ,_„^_(to) ._�. <br /> Geologist Bentonite (from} <br /> Grout <br /> Chilling rig type <br /> SPECtaL PEK&T SNFO; Auger O.D. I.D. <br /> Completion-Stove pipe/clzristie box (circle ane <br /> Distance to sewer Tine „� �1�f V <br /> Domestic well on site - (Y! n) ' "t <br /> if yes, location and distance- CONST _ <br /> V P—UCTIQN � V <br /> Well Na, <br /> -� <br /> Total Depth. <br /> Screen Length (from) (to) <br /> Filter Pack (from) —(to)^i25 - <br /> SAMPLSNG > Bentonite (frau) (to) <br /> c Grout (from)_. —(to) <br /> Holding Temperature —...; Drilling rig type <br /> u, <br /> Method, Auger O.D. I.D.,-_ <br /> Screening Method Completion- Stove piWchristie box (circle one) t <br /> Trucking Shcet - l n ., <br /> SPOILS <br /> g _�z' Iv MRI&..2MEVELOPMENT <br /> Storage Method , . <br /> Contaxzi3ination Noted <br /> Storage Location Casing type <br /> Blank ft. }Screen <br /> Slot size <br /> GROUTING Bags cement + <br /> Buckets bentonite 4 <br /> Depth to seater t Sags sand/gravel <br /> Mix RaFilter Pack type/size ` <br /> Installation Method Surge Block: - (y/n} _, <br /> Quantity Installed- Discussed with geologist. <br /> #Type of method <br /> EH 29 29 # y Y <br />