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(0&iTORING WELL INSTALLATION REPO <br /> r� <br /> Date: tit CONSTRUCTION <br /> Premise Address: A'U(S' NWA- W At-4Yq,-�fJTotal Depth <br /> Screen Length (from) cto) <br /> Well No.: W Iq Filter Pack (from) '{ (to) <br /> Bentonite (from) (to) <br /> Inspector: CS _ w Grout (from) (to} .e--• <br /> Drilling rig type 01 4 Cs 6: <br /> Permit No. . 26�6 Auger O.D. <br /> Drilling Company:. Completion - Stave pip 'stie box (circle one) <br /> .. �lCa ����iC �, .. _ <br /> r <br /> Driller: casing <br /> Consultant <br /> r" T height <br /> e{ght <br /> • �_�?��� G-�L-�`�-� <br /> - r <br /> Geologist NUS C.DngIC'JC� <br /> ABOVE-GACUND <br /> COWLETION �+ -6iAXTY-SOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line <br /> Domestic well on site - (y'9) ft- <br /> lf yes, location and distance - M <br /> it. <br /> Vh m <br /> o+ p <br /> SAMPLING asorai <br /> Becket " — <br /> HoIding Temperature G " _ Pack <br /> Method r'T . �: <br /> Screening Method " '-- <br /> w' <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method G 1\9U,,&4 S, MATERIALS/DEVELOPMENT <br /> Contamination Not d - ( ry/ n } <br /> Storage Location q/l0 -w' ' Twj 4141 Casing type Z,� !�;C64 40 <br /> BIank =ft. Screen ft. <br /> Slot size ' 0- 0 2-o <br /> GROUTING . Bags cement <br /> Buckets bentonite <br /> Depth to water 4-7Bagssand/gravel S <br /> Mix Ratios Filter Pack type/size Y ` <br /> Installation Method Surge Block: - ( y/(5) , <br /> Quantity Installed Discussed with geologist: - ((1 n) <br /> Type of method <br /> EH 29 29 <br /> '%W v LdfNv-) 4AVs ! /A1 OWMIL-r AVLT �5 <br /> �zt <br />