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M01 +RING WFZ.L INS—LAU TION REPORT <br /> Date: 7- / CONSTRUCTION <br /> Premise Address: ZO (off Total Depth 15 <br /> Screen Length (from) /S (to) i O <br /> Well No.: /46�) ZZ Filter Pack (from) 15 (to) 8 <br /> Bentonite (from) (to) <br /> Insoec•or: Grout (from) !v (to) O <br /> Drilling rig type 53 <br /> Penr:ic No, Auger O.D. I.D. & TV <br /> Completion - Stove pipe/ rstie box (circle one) <br /> Drlling Company. ch <br /> casing <br /> Drillers -T height <br /> ♦f 7 *==_1 <br /> ConsultantC?rt� �l.3CVEvROt:ND G2010�P1SL -- CVtFLZN <br /> Ground SLrfxi <br /> SPECIA1 PE::LWT INFO. If <br /> grout <br /> Distance to sewe-*line AIA <br /> Domestic well on site - (y/'n '�""�"'�'ft. <br /> If yes, location and distance - ft' <br /> eft. <br /> q+ O <br /> O <br /> aloud = o <br /> SAMPLING ` s�csan = � <br /> Holding Tempe e '* <br /> Me;�`�od _ <br /> Screening Method <br /> Tracking Sheet y n ) tL <br /> SPOILS <br /> Storage Method �^—f� MA i RIA.LS/DEVELOPk ENT <br /> Contamination Noted - y/ ) <br /> Storage Location ITS Casing type r <br /> Blank Screen S ft- <br /> Sloc size 00 z <br /> GROUPING Bags cement 3 <br /> Buckets bentonite_/ <br /> Depth to water �l \\ Bags sand/gravel <br /> Mie Rados 2 t #4,6(Pe� Filter Pack typesize /C <br /> Ins:allat.•on Menhod 2 .^.—� // Surge Block: - (y n <br /> Quantity Installed 3 64-c n•46 Discussed with geologist: - (y An <br /> Type of method — <br /> ��t� -72,A <br />