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Gr=r1 Scs <br />=tvPi...:777.C144 <br />casing <br />height. <br />95, <br />groct <br />90 • <br />9 3 <br />slattpd <br />ML 41DRI4G WELL 'INSTALLATION REPO <br />Date: 9r/3 `° 6 <br />Premise Address: / <br />51) <br />03.969 <br />Drilling Company: <br />Driller 1-04A- <br /> <br />nsulv.r.t <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site- C y 0 <br />75' <br />If yes, locznon and distinct - <br />SAMPLING <br />Holding Ten)perature 7e.-- <br />Method Oa 42/.42-7 <5'7'6"dr-'• <br />Screening Method V" <br />Tracking Sheet - ) <br />SPOILS <br />Storage Method 0)1 661,4064 <br />Conr=i7.-..adon Noted / <br />Storage Location <br />GROUTING <br />Depth to water <br />MI Rados / sca4 syd <br />Insullanon Method <br />Quantity Installed ' <br />CONSTRUCTION <br />Total Depth /CO <br />Screen Length cfro=0 93 (to) 10 0 <br />Eater Pack (from) 0 (to) 3 <br />Bentonite (from) 3 (to) <br />Grout (from) (to) /51 <br />Drilling rig type 75 <br />Auger 0..D. LD. <br />Completion - Stove pipe/claristie box (ca-cie one) <br />MATERIALS/DEVELOPMENT <br />Casing type <br />BLar- <br />Slot size <br />Bags cercmst <br /> b=tonite <br />Bags sand./r.xvel <br />Fat=- rack type/size <br />Surge Bloc - (y 0 - <br />Discussed with geologist (y <br />Type of caezhod <br />Well No.: <br />Inspect° <br />P ennit <br />21 <br />ft. Screen <br />.0/0 <br />Q, is