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�8 <br /> Date: t 4-L- CON=U=i CN <br /> ?-e^ise Address: �2y £ 6 j Tocal Depth <br /> Steen Lenge+`: (Porn) 5 (to) 3-5 <br /> Well No.: l6 =:Iter Pact (froth) <br /> 6 (froth) 33 (to) 2� <br /> Insoeccor. Grout (from) (to) <br /> /, 9 Drilling ng type <br /> Z 3v/ Auger O.D. I.D. <br /> Pe.^it No. 0-• <br /> Compledon - Scove pipe/chrsde box (circle one) <br /> Or1lung Company. <br /> ' p _ _,_ cas-ing <br /> Corsulmnr nn__ <br /> Ism /ap A3CV--aRMNO \\ , <br /> Geolo st , <br /> S?EC'AI. ?ER.�tIT INFO. <br /> grout <br /> Distance to sewer line <br /> Dor--esdc well on site - ( y/ n) <br /> If yes, location and distance - <br /> — e <br /> tlorad <br /> i�1G t�cian "" '— <br /> S�_ Ivr �• _ <br /> Holding T emperacure <br /> Method <br /> Screening Method _ <br /> Tracking Sheet - ( y/ n ) ♦ _ ♦ tt. <br /> SPOILS "_"' p <br /> Storage Method 5,5 5�"k � 'eta i-R .AiS/DEVcLOPIyCy"C <br /> Coma.ninadon Noted - ( y n� 46 t/c <br /> Storage Location N Casing type <br /> Blank ,95 ft Screen b ft <br /> Sloc size ©Z <br /> GR0U7,NG Bags cement <br /> q, Buckets bentonite d' <br /> DevEh co water ° ! Bags sand/gravel ice= " <br /> Mis Rados IS fi"2 Filter Pack typesize <br /> Inscalla-6:on Method Surge Bloc'-c: - (D a ) <br /> Quant Ly installed Discussed with geologist. - n ) <br /> Type of method O­L�WIZO� <br /> /4Gl/ /4/3 ae-& <br />