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MOSING W_L' INSTAL ION R`PORT <br /> Date: CSC �Ii �! �!� CONSTRUCTION <br /> P-e.se Address: r Z� Toral Depth. _ L5 <br /> J Screen Length (from) 2 (to) <br /> Well No.: wtall / FIIte Pack (from) 25 (to)�— <br /> Bentonite (from) f (to) <br /> Inspector. Grout (from) ! (to) G <br /> Drtlling ag typeE 775 <br /> Pennic No. Auger O.D. I.D. <br /> Drilling Company: <br /> �E Completion - Stove pipe/c:risde box (circle one) <br /> Drlle dG� f / eas_:zq <br /> •I� = height <br /> Corsulran: 6E <br /> Geologist � 1 L��%e�C �lSCVEGaCCNO <br /> G.^Mr'=�fCN CtR:5 Y-aCX <br /> CMP'—C. <br /> Qv od SL-tact <br /> SPcrtar PrR:4IIT INFO. � <br /> gfoct <br /> Distance to sewer line �NliQ )'/oa = <br /> Domescc wet on site - ( y/ a tt <br /> if ves, location and distance - S <br /> c <br /> SAMPLING abctad = c <br /> Holding Temperature y� L _ � ''acX <br /> Method Ca� S � �✓ � = <br /> Screening Method -)Cj A _ <br /> Tracking Sheet O n ) .. 7 <br /> .. � r <br /> SPOILS <br /> Storage Method Oe.,— MA7-=4I.A S/DEVELOP?vFN7 <br /> Contamination Noted - (y/ n) Z n <br /> Storage Location A ti/t( ming type <br /> ffian c S tc Screen 2-U fc <br /> Slot size - 0-- <br /> GROL:NG Bags ryctt z <br /> Bucker benconite <br /> Depth to water /3 �L Sags sand/gravel <br /> MLX Rados — Fater ?ad:typesize 3 <br /> Ins callacon Method — Su-oe Bloch: <br /> Quanccy lnsralled a Ducssed with geologts - �/ n ) <br /> Type of methodi2�� <br />