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MOTORING WELL INSTALLATION REPORT <br /> Date: ��^ I O 1 CONSTRUCTION <br /> Premise Address: l ' ''� t S�0.0 S Total Depth S <br /> l Screen Length (from) A S (to) <br /> Well No.: Filter Pack (from) <br /> Bentonite (from) a l (to) ;k-3 <br /> Inspector. Grout (fro ) I (to) 2- <br /> Drilling <br /> Drilling rig type <br /> Permit No. �$ b Auger O.D. N <br /> .d Completion - Stove pipe irtstie hos )(circle one) <br /> Drilling Company: Waa� <br /> Driller: casing <br /> height <br /> Consultant l v <br /> Geologist -- <br /> ABOVE-GAMND CHRZ7Y-(3OX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfacs <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) oZl ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> C <br /> O <br /> SAMPLING •Ior.� _ C <br /> sxlcn "— <br /> Holding TemperaturePack <br /> Method = <br /> Screening Method ;r -= <br /> Tracking Sheet - ( y/ n ) Ll 4 _ <br /> eft. R ''L5 ft. <br /> SPOILS 1 �Q <br /> Storage Method_S ~ ` �f""" MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/ n p � C /► <br /> Storage Location Casing type T <br /> Blank a.5 ft. Screen ft. <br /> Slot size .07' <br /> GROUTING Bags cement <br /> 1 Buckets bentonite <br /> Depth to water Bags sand/graveI <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y ti ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method <br /> EH 29 29 �� <br />