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MOir:ORTNG wEI L INS�aT T ATfON RSO T <br /> Date: i <br /> Tomi Depth <br /> . .e=Lce Address• Sce---I.-ngm Cpm) !a_ (to) S <br /> :-=Pack Cfrom) A2 -(to) <br /> Well Nom �l/ w / Bentonite <br /> o� Grout Cpm) Cto) <br /> Insoecror, l�i�A' Drilling rig type /�-✓s,�` <br /> Anger O.D. I.D. 3 c <br /> pe-*-=;r No. O/ 7 7 4� Completion- Stave pipe/chri:ie baa (I=r= ane) <br /> DrMing Company: <br /> Dr+?1er: Ll ii-i GL-oto ✓ � .� t ( ♦ he• h� <br /> Geologist J137N � D :5-y X <br /> S?ECIAL arm- a <br /> ^rix. <br /> i <br /> Discance to sewer line <br /> Domestic we1- an site - <br /> If yes, Location and disc nce - Ovewl <br /> /`j/\ �JAIvCo LING it.^T.fia a <br /> +no+;,a=c <br /> iding Temperate A <br /> ` Me hod � =_ <br /> Screening Method — <br /> Tracldng Sheet - C y n) / /a _ _ ♦ /t� 1'L <br /> SPOILS <br /> MA7----JIAIS/DEVFT..,OP14iLN <br /> Storage Method <br /> con-ammamon Noted- C y a) <br /> Casing type ;. <br /> Storage Tocaaon Blank 5_ u Sae- <br /> Slot size <br /> GROUTING Bags �� <br /> Bud= bentonite <br /> Gj Bags R�.o tysand/�� �o <br /> Depth to water rpesize <br /> Mia Ratios a 777 Surge 3106c - C y n) <br /> Installation MethodeDio Ins-called <br /> with $ �"'-- C y <br /> Quantity - <br /> :•ype of method <br /> ^: 20 29 <br />