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MO!' "JRING Wx,.LL INS—LALLAiTON R--DORT <br /> ti <br /> s <br /> Dace: I p� CONSTRUCTION <br /> Premise Address: . j 24 �• _ Total Dep lth i Z� <br /> i / Seen Le. gth (from) <br /> Well No.: (P FUlte: Pack (from) 7-6v (to) <br /> Bentonire i,. (from) <br /> Inspector. Grout (from) (to) 0 <br /> _ s3 <br /> / Drilling:ig We <br /> Pe.-nic No. r �� Auger O.D': 10'14'4_ I.D. ? 2 <br /> £ T Compfedan- Stove pipe/chrstie box (circle one) <br /> Drilling Company: <br /> i!. casing <br /> i;.- Driller.._ /4 -e JL Gry"'" —AF?height <br /> Consultant_ - <br /> s w <br />' Geologist <br /> Ground Su la" <br /> SPECIAL PER-WIT T INFO. <br /> Distance to sewer line <br /> Domestic Well on Site - (y/(V <br /> � <br /> If yes, location and distance ;ii <br /> t. <br /> SA1LIPLING ?r; <br /> _ a <br />! NoldisZ Tem eratttre �G <br /> g P ,. <br /> Mehod <br /> Screening Method <br /> i Tracking Sheet On ) <br /> SPOILS <br /> �5 <br /> Storage Method MA i-RltIISII3£VE_LOPIVCENT <br /> Contamination Noted - (y On 0/c- <br /> we <br /> i,StoraLocation Dk Casing type <br /> Blank ;E. , fL Screen 8 fc. <br /> Slot size <br /> GROLMNG Bags cement 3 <br /> Buckets benconire 172- <br /> Depth <br /> ZDept.`s to water � Bags ' <br /> andgravel <br /> •� <br /> Mir Ratios 0 7°r �$ P G Filter Pa fti';t pe/size s <br /> Installation Method Surge Block. - (y n } <br /> Quantity Inscalled 3 Discussed i geologist: - ( ; n ) y <br /> Type of method :' <br />