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— _ M0N4rOFING WElLMiSTAIlATION RFPOP-T • <br /> Date: <br /> Total Depth lllL _(to) <br /> premise Addtesr <br /> Sween Length (from) <br /> FilterPacc Cfrom) Cco) <br /> Wel No: Bcnroaice CF-om) Cto) <br /> Groat (L-om) Cro) <br /> jrz=ictoa DrMing rig type LD. <br /> O U 2ZlTilo Auger OA- <br /> Permit Np: Completion- Scove pipe/christie box Ccc�e owe) <br /> _ I � 1 heiSG= <br /> Duller 71 I <br /> T <br /> �y <br /> Coasultzat � <br /> C�ologis =eP`IE-I=N Ct.tP C-4 <br /> SPECIAL PER ,97 INFO. grit <br /> Distance to sewer linerA <br /> Domestic wet Or- site - a) h !o <br /> U Yes,loczdoa and distance <br /> s0 � N = - <br /> 20 � 98 <br /> y <br /> SANT 2 y3 <br /> Fjolding Temperature <br /> Method N F, �: <br /> Screening Method <br /> Tracking Sheat - C Y a) <br /> SPORS <br /> MATUJAISMEV OPTE-'r <br /> Smmge Me od <br /> CO moa Noted - C Y n /C Casing ty;M / 7 OA Q_ <br /> Scourge Location <br /> f� BtaaY y <br /> Slat SSZe .o 2-01 , <br /> Bags cemClt <br /> GltiOUT NG B=,ice be=caire <br /> Bags S=d/g xvel <br /> Depth to water Fate_pack 7Pdsae <br /> Dor=Rados Surge Block: - C Y a <br /> jnsr ladoa Method Di.==ed with geologist- C 7 <br /> Qua¢tity Instated Type of method <br />