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!R NG W_•' IRNS LA ' A� LCN R�- OR: <br /> Date: 2 �- /9�� Q_iLO/kJ� ' CONSZU=ON <br /> ?res se Address UIV1Gcx 107L� r ptR/� Local Depth :5, L5� <br /> ( <br /> Secen Lr--2 ,h Eo (to) S <br /> Wel No. `/G(ilitl� Fite^ ?arc (L-0m) Z CEO)- <br /> 25 <br /> 3Lticonire (from)_ �S (to) ' 2- <br /> [nspectoe Grout (from) (to) o <br /> Dib 3Z0 Drlling rig type <br /> e.^...1•[ Vo. ?urger 0.17. crS Imo. <br /> Ti p� Compledoa- Stove Pip <br /> We e/chesie box (circle one) <br /> Drilling Compaay._ �� �.t.(�Z_ / <br /> Dr1 er. I1/Yll �f/A eas'_.zq <br /> Corsullranc ^ ' _ ;�� : he; <br /> Geologist t3Cv=.>ACCND WYE) <br /> Cr'hr'_iCN C7iFi5�!3CX • <br /> CCMP'CCN <br /> er-�r oe �� -n Grzz15�-!aet <br /> 50' w "" <br /> Dura:tce co sewer 1" .50 <br /> I <br /> Domestic wet on site . (y/ n li {t- <br /> If yes, location asf'j eistaace - 3 L <br /> ✓rlt-� /COc��%� trJC.2t' .ate r _.�_.iL ; - _ � � <br /> 0 <br /> s?VI?LiNG ilacae _ c <br /> L'oldi.g Temneracure = = gavel padc <br /> Method = i <br /> Scat.-ting Me_tlod _ <br /> Tmccfag Sheer. C y/ a) <br /> ZS _ <br /> • IV <br /> SPOILS <br /> Storage Meti:od VLA iMAIS/DEV=!OPLL T <br /> Contaminarion Noted •ty/ a ) nn <br /> Storage Location Casing type 2 <br /> Blank S ft See-^ 710 fL <br /> Sloc size .OZO <br /> GROII?ING Bags C=ent <br /> Buckets bentonite <br /> Deot.4 co water - 4 Bags saad/�avel <br /> titix Rados $ Qq FIce:Pack rype/size <br /> Installation Met:ad I� Su*oe Block. - (y/ <br /> Quay Lu ailed Disc sled with geolosir - (y/ n ) <br /> Tyle of method <br />