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MOI.C NG WELLItvSTALLATION REPORT <br /> Date: U CON=UCITON <br /> premise Addresr. *I Tool Depth <br /> Screen Length (from)—(to) <br /> WtIl No: �(/!V FSw Pad'c Cf om) (m) <br /> Bencoaire Camm) C:o) <br /> ?asp_ector. Croo± CLom) (to) <br /> Dr�Img rig type <br /> ?esmit M-. Ange O.D. I>. <br /> Comoletion- Stove pioe/christie box (circle oat) <br /> DnUing Compzay: <br /> cas?cq <br /> Driller TI� i aeig<zd <br /> Consu!raat <br /> Geologic Ju^vS Ctt� <br /> g&pI <br /> -- <br /> Gr�-s15�jr+ <br /> SPECIAL PERMIT INFO. <br /> spa~ <br /> Distance to sewer !int CS 0 /.5 <br /> Domestic weL or: site - C y/ a) f <br /> If yes, loczrion and distance - 15 <br /> ya _ <br /> [, \ YS <br /> �r <br /> SAMPLII iG — 0 <br /> D <br /> Holding Temperature 70 <br /> !o$ <br /> Method 711.5r <br /> Sc*»rti*+g Method VI 9S <br /> Tracking Sheet - C y/ a) /os s <br /> SOILS „0 = <br /> Storage Method MATSUAIS/DEVELOPMENT <br /> Cano=- iaarion Noted- C y/a) Casin; <br /> tgpe <br /> Storage Locarioa Blank Sue <br /> Slot sa <br /> GROUTING Bags <br /> LL--__ Budee� besronire <br /> Deoch co water ^�_g� aSC' Bags sand/;_avel <br /> Mi Ratios Fiter Pack typelsae <br /> InsaIIarioa Method Scnge Block: - (y <br /> Quactity Installed Discussed with geologist- <br /> Type of method <br />