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WEU 10STAL-LKCION 11FPC­ <br /> Date: �5 CONSTRUCTION <br /> Premise Address:— Total Depth <br /> screen Length (from) jJ-- _0 (to) A' <br /> Filter Pack <br /> Well No.:_LVQ--_Q � <br /> Bentonite (to) Y) <br /> Grout (fron-1) !s_1 <br /> Inspector: (to) <br /> Drilling rig type- <br /> Permit No. 96Y, Auger <br /> Completion - Stove pipe=li— b <br /> (circle one) <br /> Drilling Company:._ Lu s{ U <br /> Driller: rpt C casing <br /> height <br /> Consultant LL <br /> j���- e-t'-�4-'et-e <br /> Q. <br /> ABOVE-GFIOUND <br /> COWFLETIoN P! IMI <br /> SPI�CIAL_PERMT INFO, <br /> pc <br /> Distance to sewer line <br /> Domestic well on site - (y/n <br /> If yes, location and distance - it. <br /> SAMPLING slotted <br /> soc�on A <br /> Holding'rempel ature g Pack <br /> Method <br /> screening method <br /> Tracking Sheet Y n) <br /> SPOILS <br /> ju <br /> Storage MethodU <br /> Contamination Noted f(Y n ) <br /> Ing type <br /> Storage Cos av���6 <br /> Blardc_JA)__ft- Screen 0—ft, <br /> slot size - <br /> GROUTING ----- <br /> ags cement <br /> uckets <br /> Depth to waterAll# B,as saptg�'a gel <br /> Fil -Cr Pack type/sho, <br /> Mix Ratios -----------------;-- <br /> Block: - <br /> Installation <br /> Quantity Install c d Discussed "vith geologist: - C ja <br /> ormediod. <br /> EH 29 '�9 <br />