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� 1NrIIORING <br /> WML U"TAUAMON <br /> Date: s " <br /> RUCTION <br /> Premise Address: ve_�. Total Depth__ _ . . <br /> Welt No.; -zz4 /jj Screen Length (from) fto) S <br /> Fater Pack {from) 15 <br /> Bentonite {froth) 00 <br /> Inspector. Grout (from) 00). <br /> Permit No. 0U Drilling rig type, <br /> Auger O.D. <br /> Completion-Stove pipe/chrisdo box (circle one) <br /> Drilling Company: <br /> DrSter. J[w� cas inq <br /> haight: <br /> Coaaultant <br /> Geologist .� <br /> Aao11B-aRONVO ,� . <br /> COMPLETION wo. COMPLETIONC3e+ot�d Sa'fa� <br /> Distance to sewer line irk <br /> Domestic well on site- feyy n) <br /> Il'yes, location and di: e- <br /> Wood <br /> . i�G�ofl R54 <br /> Holding Temperature <br /> Method = tam P <br /> Screetsitig Method - .-= <br /> Tracking Sheet - (y/n) ' E <br /> is <br /> Storage Method M6jWU GS/D'EVELOPMENT <br /> Contamination Noted- <br /> I r PVC <br /> Storage Locati Casing type a <br /> BI #t. Screen /0 ih <br /> Slot size Y <br /> GRQLMNBags cement <br /> Buckets bentonite <br /> Depth to water,, _ -- Bags sand/gravel <br /> Mix Ratios Filter Pack type/size. _, a <br /> Installation Method Surge Block: - (y/n] <br /> Quantity installed <br /> Discussed with geologist: - {y/n) <br /> TWO of method <br /> EH 29 29 <br />