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MO 1 RLNIG WELL IISTALLATICN R.LPOR.T <br />Date: fid' 00 (A1) <br />Premise Addrat 224/ Ai. &idea( Pity / <br />CgA/"Aacr) Well No.: <br />Inspect° Et <br />-61e-CD 23'90 <br />Dr2Iing C.orapany: <br />Dr2ler: I- le;14 <br />ConstiL=.r.t <br />Geologist <br />SPECLAI Pc? Mr' INFrl. <br />Distance to sewer line 7 <br />Doraesdc well on size - yCj <br />If yes, location and dismnce - <br />SAMPUNG <br />Holding Tempe:2=e <br />Method <br />Sate:zing Method <br />Traedag Sheet -0 a ) <br />Sports <br />Storage Method <br />Cart-7?-tir ,don. Noted -(011. ) 0 <br />Storage T-rocatiorte-i-- <br />GROUTING <br />Na. Rados <br />ins-ziladon Method <br />Quany Las-aned <br />/5- 66 `7/1411 65 <br />flu r Ve.-47 <br />Depth to water i <br />C3NS-7.;.UCTION <br />Total Depth 420 <br />Seer. Length (from) Gob (to) 4o <br />Fate: Pack (from) 60 (to) Z <br />Bentonite (from) -57- (to) • <br />Grout Cfro4 35 (to) 0 <br />DrZing rig type <br />Auger 0.D. LD. 1-- <br />completion - Stove pipe/thriszie bolt (-zle one) <br />Bags cement^,-.• <br />Bucket benthaite <br />Bags sand/gravel <br />1.--at=. Pack type/size <br />Surge3loc. - C <br />Disc= ed with ge or:sr. • C <br />Type of method <br />io <br />9 - - <br />Permit No. <br />casizg <br />height. <br />AZSVE-SSCLIC <br />=iePt..-.717CN <br />MA=ALS/IDEVELOPNSNT <br />Casing type 2 ," P VC-- <br />Blank 40 ft. Sceen 20 <br />Slot size <br />fr.