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MO RING WELI.INSTALLA77ON REPORT <br /> Dace:- <br /> / 0 - -7 - ! 3 CONSTRUCTION <br /> CfC�� Total Depth 5br <br /> Premise Address: Screen Length (from) O (to) 3 U <br /> Fater Pack (from) Cco)� <br /> Wel! No.: Bentonite (from) 2 (to) <br /> Grout (from) (to) <br /> Inspec;nr. Drillingrig type 'f <br /> Permit No. 3 l s� Auger O.D. 3 ' I.D. <br /> Completion - Stove pipe/chrstie box (circle one) <br /> Drilling Company: <br /> ^ �' ' .� . casing <br /> Dr11er. �� - `� height <br /> Consultant <br /> ABCVC--GF;C(:NO CNSMiY-BCX <br /> Geologist t~11FLEI CN _ <br /> Grwnd StSfxf <br /> S?ECL% ?E:LtitIT INFO. groat <br /> Distance to sewer line < r L=--h• <br /> Domestic well on site - ( y/ n)—Aj 4 2$ ft <br /> If;yes, location and distance - 3� ft. <br /> 73 <br /> 0 <br /> tbttad — o <br /> SAMPLING <br /> 7191 Pack <br /> Holding Tempera e = i <br /> Method <br /> Screening Method O 1/M <br /> Tracking Sheet - y/ n ) <br /> SPOILS <br /> Storage Method f MAT'RIALS/DEVELOPN EN' T <br /> Contamination Noted - y/ n ) lO @� i35/°P Casing type 2 Pv C- S-r� 4 <br /> Storage Location Blank 3D _ft- Screen LU PL <br /> Slot size O Z <br /> Bags cement <br /> GROUTING Buckets bentonite / <br /> �� Bags sand/gravel <br /> Depth to water Fater Pack type/size <br /> M c Rados Surae Block: - (y/0) <br /> Ins-.alladon Method w+ Discussed with geologist: • C y n) <br /> Quanciy Installed lvC--" Type of method <br /> Y 56 <br /> lo- z-2 3 A60 7 <br />