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MONI'LOR_-TNG waL 2Z-l-AI:A'II0N REPOTTl !�/ N <br /> Dace: <br /> � > �rf <br /> Premise Address: t2. !Ang m (fioII) <br /> Well No.: ( sz t u7 �- :, p-Parc (tom) (o) <br /> re B - (from) (m) <br /> Inspecror. O uL (from) Com) <br /> g ng i7pe <br /> Auge=O D. �f'7, <br /> Permit No. c�F1 O <br /> Completion- Stove pipe/carsae box (crcie one) <br /> Dr in g Comp: <br /> DrMer: . ► I ` tie, t= <br /> consul=ar <br /> Q <br /> 6 G7_rtclG � <br /> Geologist 1 /� JzcVE-GROUND <br /> S?Er-IAL ? !NFO ` Grs.� <br /> .. E' Mr- Stirs , - <br /> l <br /> Distance to sewer line <br /> Domestic we-11 an site - <br /> If,yes, location and dis=c_ - ~ y <br /> 1 <br /> v ` <br /> SAMPLING <br /> -Holding Te=pe:a=e <br /> Method ' <br /> 54creening Method <br /> Tracking Sheer - 0/ a) <br /> SPOILS <br /> Storage Method MA?^�IALS/DEV T OPNEY- <br /> Conra= amore Noted - (Y/ :.) �V/✓ �� <br /> Storage Location Casing type <br /> gig - Scee3 <br /> Slot size - Ute- <br /> GROUTING 3ags <br /> Bud= bertnnire <br /> Depth to ware-- 5 Sags sand/�av� <br /> Mia Rarics =firer Pars type/s=e <br /> Installation Method -Stage 3106e - C y/ n ) <br /> Quantity Insmalled Disc:ssed with geology- - (Y <br /> Type of method <br /> 29 29 <br />