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MOi BRING WEIL INSTALL_aTION R PORT <br /> Y- V— <br /> Date: �G I f3 CONSRUCTION <br /> Pre:rise Address: o2 7� �� �/� Total Depth �O <br /> / Screen Length (from) O (to) 76 <br /> Well No.: /� �P Filter Pack (from) O (to) 6� <br /> • Bentonite (from) ('05'1 (to)� <br /> Insoec-or. Grout (from) 62- (to) <br /> Drilling rig type / 4-?Eo <br /> Permit No. 3Auger O.D. I.D. 3 ' <br /> Completion - Stove pipe/chriistie box (cir(-le one) <br /> Drilling Company: <br /> n u C cas:zq <br /> Driller. ♦ height <br /> 1 ♦ 7 <br /> Consultant <br /> Geologist \� A <br /> i CN <br /> Cv=rd SLTIacf <br /> SPECIAL PEiZ:'Iv'QT INFO. � <br /> Qroct <br /> C4 is <br /> Distance to sewer line N14- <br /> Domestic well on site - ( y n <br /> Y loy n, <br /> if yes, location and distance - ft' <br /> ft. <br /> = o <br /> sicnad = c <br /> SAMPLING — <br /> s+c:on {' � <br /> Holding Temperature dot c� -�� S� _ 91 VI Ca. �. <br /> Method <br /> Screening Method <br /> Tracking Sheet y n ) <br /> SPOILS <br /> Storage Merhod On F 14-Kolu 9 MA i cRIALS/DEVELOPMENT <br /> Contamination Noted - ) �� <br /> Storage Location ,in4 Casing type 40 ��C- <br /> Blank --70 fL. Screen---- 2c) f[. <br /> Slot size 1, <br /> GROUTING Bags cctntat <br /> Buckets bentonite <br /> Depth to water 7q Bags sand/graveII -7 E 7 Z lib <br /> Mir Rados f k typ <br /> Z3 - o Filter Pace/size <br /> Installation Method Surge Block: - a ) <br /> Quantity Installed Discussed with geologist: - Cy_ ' n ) <br /> Type of me•hod <br /> 2. /�`t'� <br />