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,VO' BRING WFI . INSiAU-,k',7ON REPORT <br /> NOW <br /> Dater (�!7' Z�pL�g3 -- CONSTRUCTION <br /> Premise Address: ` Total Depth <br /> Screen Length (from} (to) /O <br /> Well No.: I�GtJZ Filter Pack (from) / (to) <br /> Bentonite {from) Z (to) <br /> Insoec:or. Grout (from) 7 (to) <br /> Drilling rig type �% / <br /> Pe-m—it No. Auger O.D. /o L,/If - I.D. G <br /> Completion- Stove pipe/chrsrie box (circle one) <br /> Drtling Company,-- <br /> casing <br /> ompanycasing <br /> Driller. height <br /> Consultant <br /> UA� Aj;V-•GRCCNO \� <br /> G2410$ISL C*SZ-1 Y-aCX <br /> C.OMP:_=ICN <br /> Ground Sulaca <br /> SPEC:ar PER-MIT INFO. <br /> Scat <br /> Distance to sewer line N A <br /> Domestic well on site - W n) g z fL <br /> If yes, location and distance - 1wn. <br /> w N <br /> A5 dUJZ <br /> 0 <br /> sla6d = <br /> SAMPLING an K' <br /> Oh- C.cre- ,; drawl,,ac+t <br /> Holdling Terz;perature <br /> Medhod <br /> (fit <br /> Screening Method <br /> Tr acldng Sheet y n) �s fL <br /> SPOILS <br /> Storage Method nt h Ai--RIALS EVELOPNLNT <br /> Contaminarion Noted - 9a) <br /> Casing type <br /> Storage Location <br /> Blank /O _ft- Screen :S fr- <br /> SIot size J <br /> GROU"1'ING Bags cement f-3 <br /> / J Buckets bentonite l •%6 3 * t2 -Le— �-P <br /> Depth to water N ti /�'r'w ( 17-o Bags sand/gravel 2 55 d <br /> Mie Rados Filter Pack type/size �A <br /> Ins:allaron Method Surge Block: - (y/ n)—►�{A <br /> Quantity Installed Discussed with geologist: - ( y/ n) <br /> Type of method <br />