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MOS <br /> it.C�� a� ``Z` 5 CONSiRUC77ON <br /> Date: CI <br /> 'E' Total Depch T <br /> ?-emise Address: �" Sceenn L=gth (from) -5 Cto) 3 <br /> v�11 �� /��✓'��s✓E Filter?a6c (from) q3 Cco) 3 0 <br /> j Well N /v <br /> o.: Uncomic! (lion) Z7, Cto) <br /> Grout (from') Z (to) O <br /> Iru?ec:or. Dt�ling:ig type ca, SSb <br /> �`/��O(�5399 ger OZ. 12Yz'' I.D. <br /> Aug . <br /> Pe_^a No. Comoledoa - Stove pipe/c:�s::e box Cci=le ane) <br /> Detling Company. <br /> � � T♦I 71T <br /> iheight <br /> Co rsu!ta.^.c ' <br /> ACX <br /> Geola;.st OC .l3Cv: RCt.NO ;5;' <br /> Gcoc:nd S��xs � <br /> S?Ea% ? _M17 !N- FO- Q[aci Ly <br /> Distance co sewer line 1414 2-7 <br /> Doresdc well on site - C Y <br /> if yes, location and distant= ' ��• � <br /> d _ <br /> r = � <br /> :oldir-g Temperate- -_ <br /> Sc:etning Method <br /> L acting Sheet - a) Z"72.0 e/v Lel z" _ <br /> I y� <br /> S?OILS <br /> Storage 'Method �� T P V Q- <br /> Contamination Noted - C y/ a Casing type `7� — <br /> Scorage Location Ilh .Q� Blame 33 fe Steen x0 ti <br /> Slot size o I <br /> Bags ce=en 7 <br /> GaOL::NG <br /> Buckets be*�w..�t� <br /> ? Bags saad/gavel <br /> Deoch co water 3 Ater?ac!c ypelsEc 3 L <br /> tifLY ?.ado5 105 f <br /> Ins;alladon �ie_:od Surae Block*. - (� a) <br /> Quand:f Installed S J cisc=ed wi44 geology - ( <br /> Y n <br /> Type of merhod <br />