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&TORING WELL INSTALLATION REPORO <br /> Date: ( yyjCONSTRUCTION <br /> Premise Address: f zr l/ yJ ii ��3IV A+ ''Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector. . Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> P Completion - Stove pipe/cluistie box (circle one) <br /> Driller: T casing <br /> Cg� r height <br /> Consultant <br /> Geologist__/,-)// <br /> /> J l &222 <br /> A80VE-GRCUND CHiISTY-80X <br /> CCMPLSfION CCMPL-MnCN <br /> SPECIAL PERMIT INFO. G=nd Sumac+ 7� <br /> proof <br /> Distance to sewer line <br /> Domestic well on site - (y/ n ) ft. <br /> If yes, location and distance - ft. <br /> tt. <br /> -- a <br /> SAMPLING dorm <br /> aac'cn <br /> Holding Temperature <br /> Method ^ _ <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> SPOILS _ <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted <br /> Storage Location �/ C Casing type <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n) <br /> Type of method <br /> EH 29 29 <br />