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vtor ""giNG wF:..:.I�iS i•AT�;,1:T'1cN RZ--JoltT <br /> CONS T RUCTION <br /> I;. / 31YTotalDeptah gS � <br /> p-emise Address: Screen Length Orom) C to) (� <br /> Flter Pat's (from)_,_ `d 5 (to) L well NO.: Bentonite (from) (13 (to) (cfl <br /> Grout (from) <br /> Inspec;or. ,P� DrsM ng:ig type C%YK-F <br /> yl�6o/ COS � �'`rP3 3 "�6 oy Auger O.D. I.D. <br /> per..:it No. Completion- Stove pipe/ch,'41sie box (circle one) <br /> Drilling Company. ,mAir- . <br /> cas i ag <br /> Z. height <br /> Driller. 7� � ♦ ♦ <br /> CorsulzantGeologis <br /> ��8-vc �/6G./.✓S �3CV�-uRO�IND �'-3CX <br /> C,cound suz=* : <br /> S?erW at ?E. T Iti:-O• fltoLt <br /> so inn <br /> Dista^.ce to sewer lite <br /> Domestic well on site - C y/@�D <br /> if yes, location and distance - �5 ti• T- <br /> '� 3 <br /> ze C <br /> iK..on <br /> SAMPLING <br /> l-Ioldi^.g Temperature <br /> Me*hod — <br /> Screening Method 7 " _� Ir N1. <br /> Tracking Sheet - y <br /> SPOILS <br /> MA i r�IALS/DEVfiLOP1�T <br /> Storage Viehod 0�'� £ �'"� � — �D <br /> Contamination Noted - C y AD ming type Z <br /> Storage Locarion 0�'` Bl= b S fL Sceen Z- <br /> Slot size •O�-- <br /> Bags cement l <br /> GRO-UiiNG Buc'-cets bentonite <br /> Bags sand/gravel , - <br /> Dept4 to water _ S Filter pack We/size 3 _------- <br /> Vtix R acos l i7,� <br /> Ins;allacon Method V Surge Bloeti: • (y/ n <br /> Disc,=ed wide geologes:. • n) <br /> Quanw;y Installed 3 0- ! Type of method <br />