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i <br /> I u - <br /> CONSTRUC["IOb7 <br /> Date: <br /> Totat Depth <br /> Premise Address; �K � p L <br /> Screen Length (from) (to) <br /> Filter Pack (from) <br /> 'NellItiTo.: - — <br /> Bentonite (from) (to) b <br /> f Grout (front) (to) <br /> Inspector: Drilling rig <br /> C3a'z Anger O.D, ,f <br /> Permit No. <br /> Conypietlon - Stove pipe-'T<'i»�"sTae (circle one) <br /> Drilling Company: <br /> Driller: l Fn� <br /> height <br /> Consultant <br /> 1 � <br /> Geologist U d �1 ABOVE-GROUND <br /> CCMPLETION <br /> egzC!od Suri <br /> SPECIAL PERMIT INFO. <br /> Distance to sewer line <br /> Domestic well on site - { y l n ) 'l" <br /> If yes, location and distance <br /> lta <br /> Flo � <br /> _SAMPLINGING <br /> Holding,Temperature j <br /> Method <br /> Screening Method _ <br /> Tracking Sheet - y n ) , ~' (, <br /> u q w eta <br /> SPOILS <br /> ` � �. Q�ll TERIALSIDE�ELOP 1�1`I' <br /> Storage Method <br /> Contamination Noted y n ) ,p �t <br /> Location <br /> Casing e `QVC"- <br /> Storage 1 <br /> t r Bl ft. Screen { fe„ <br /> r Slot size —L A_�W <br /> GROCiTIILIGfT1 Bags cerctentt � <br /> 1� �rto nite� l ' <br /> rav x� <br /> } '' ckets . <br /> Depth to water ._ <br /> ' C }I iij:er -ack iype/si7c� 4 �? <br /> 1\1fii Ratios /-S,k, Block <br /> Installation iVlethod � lsCr_ �� , t} yt" vtf dP Discussed "v1th gcotogist: - <br /> Qti,antity Installed — _ <br /> Type or raetllad ok <br /> 1 <br /> EI-I 29 29 <br />