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MOt.�!NG W°_ ' [i S .� - -iONoOitT • <br /> �ZII �lL CON�ON <br /> Date: r(90 Ir/ Gla.n..Cu <br /> TSvc k6 Tom <br /> Depth ' /3 <br /> ?-em se Address: (L— /U S4=ml Length DMI, CEO) <br /> Fite:pack Cfrom)��Cto) !0 <br /> Well No.: U� / Bearonice <br /> Grout Cl;om) (to) <br /> Inspector. Driling:igtype 6/ <br /> 2� At:ge: O.D. /c ID. S <br /> per is No. p �y Comoledoa- Stove pipe/&zsde box (circle one) <br /> ✓1 2 e (n swim <br /> Drilling ComoanY— <br /> ` � heigCu <br /> Dr11er. Y `� ♦I� -- <br /> i <br /> Corsu!tanc <br /> /.�,w�� �� °,CV�vfiOl.'ND - CtAS"!3CX <br /> Geologist �iC1J d = p'f- 1CN C; gyp=CV <br /> Gr=x)d Stzeaea <br /> S?cr;AT. oc V4T ?NFO. grout <br /> r �_tL <br /> Distance to sewer line /N 4 — ��•L <br /> Domesdc we-11 on site • C Y/ <br /> It yes, location and distance <br /> �— <br /> 3 <br /> K' C <br /> O <br /> tiamed :f = C <br /> t�c:on <br /> S�yI?L?NG �•• � �ayvi�ac.+t <br /> =_ <br /> Holding TemperaM.r• d4 _ I <br /> Method <br /> Sceening Mehod 28 y _ t <br /> / n) y <br /> T:adtiag Sheet - C Y <br /> SPOILS <br /> Storage Method <br /> Conca-nination doted • C Y Casing type 7 ty <br /> Storage Location %m ay '� lam <br /> gly� / fL Skeen <br /> u y� G,lro47�� Slot size Z <br /> Bags cement / <br /> GROCI.LNG Buckets bentonite G <br /> Alai Bags sand/grave! 7 i <br /> Dept` to water f 7 Firere <br /> ?ack typ ��sI\Z.e 3 <br /> MLC'Rados SC e^_ 310c1c - y a) <br /> installation Method ' Disc,=ed with geologic <br /> Quancy Installed ', Type of mr_hod 2s� w <br />