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'44,010NITOWNG WELL INSTALLATION REP <br /> Date: CONSTRUCTION <br /> Premise A dress: 1� Total Depth <br /> Screen Length (from) (to) O <br /> Well No.:/AN Filter Pack (from) (to)0S'S' <br /> Benronite (f rn) (to) <br /> Inspector. Grout (fro (to) <br /> ' l Drilling rig type <br /> Permit No.� 1 Auger O.D. I At I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: � <br /> Driller: caa lnq <br /> n-1i <br /> heght <br /> Consultant <br /> 7. <br /> Geologist — T <br /> ABOVEGROUND C,HMM-80X <br /> COMPLETION CQMPLETION <br /> SPECIAL PERMIT INFO. GrCUM sudwe ••••• <br /> Distance to sewer line 041 9r° <br /> Domestic well on site - (yn ) <br /> If yes, location and distant - tL <br /> aw M <br /> �r <br /> SAMPLING tbrai = C <br /> &ocdC.A X': - <br /> Holding Temperature °G M <br /> Method <br /> Screening Method <br /> Tracking Sheet ( y? n ) <br /> b n. D M <br /> SPOILS �{ <br /> Storage Method ' UQ � MATERIAGS/DEVEL.OPMENT <br /> Contamination Noted'- (Y. A <br /> Storage Location /I1r�' Casing type V <br /> Blank 46 ft. Screener ft. <br /> Slot size . 02 0 <br /> GROLMNG Bags cement <br /> Buckets bentonite Z � <br /> Depth to water Z� Bags sand/gravel <br /> Mix Ratios A,4' Filter Pack type/size <br /> Installation Method Surge Block: - (y <br /> Quantity Installed Discussed with geologist: (y n) <br /> Type of method <br /> EH 29 29 <br />