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y. <br /> MCI JRINC 'A=-:.' I`iISrij—1AiLCN �oCRT <br /> Dace:_! 2 CONS�"�UC70N <br /> l <br /> P-em.se Address: ZZO Z Total Depth .RZ <br /> �� <br /> / 2 'J Seen Length Uroa) Z—` (to) <br /> Well No.: Xa ! Zv J "? Filter Pack (from)_ 3 �(cO) <br /> Bentonite (from) 7' to) <br /> �, Grout (From) (to} <br /> �� <br /> Inspector- ' Drilling rig type <br /> oe,^it No. ,�"� Auger 0-0. 1.0. <br /> Completioa - Stove pipe/che-sde box (circle one) <br /> Drilling Company: ✓ <br /> i ight. <br /> Driller. J he <br /> •� ! 7 �' <br /> Corsu[rz.^.t �. <br /> Geolo st '�' Cquy0 Ct,'RtSY-WX <br /> C�ftiP'=;CN CCMP_=i3CN <br /> Ground Urfxs J <br /> S25CFar P�R`riIT NFO. i <br /> Qrart <br /> Dsstance to sewer tine 6, , <br /> Daales dc well on site - ( y <br /> If yes, location and distance <br /> y~ � <br /> � C <br /> 0 <br /> c1otted = <br /> SAIMP NG sarinn <br /> Holdirg T emoe. cure - <br /> Medlod ` _ <br /> Screening — <br /> Tracdng Sheet - (y/ a <br /> SPOILS <br /> Storage Method MA i_:UALS/0EVE 0PMEN-7 <br /> Contamination Note y/ n } <br /> Storage Location �� Casing type <br /> Blardc 19,,r ft. Sees; ft: <br /> Sloc size a <br /> CROUTiNG Bags ce=ent <br /> Buckets bentoniCe <br /> Depdh ;o water Bags sand/gravel <br /> ZALc Rados Filter Pack type/size <br /> Inszallazan Vie:.^od Sur—ge Bfocli - (;•/ n) <br /> Quanacy Installed Discussed with geologis-.: - ( y/ n } <br /> Type of method <br />