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MC? 'RING We-' INSTAL' a:LON �L--2CRT <br /> Dace: q-22ZR 2 CONSTRUC-70N <br /> ?-emse Address: 2,k(z) Ce. CQLO;,- Total Depth <br /> Screen Length 05 <br /> Well No.: Filter Pack (:.om) 3S (co) 13 <br /> Benronice (from) 13 (to) 11 <br /> lnsoec:or. //�� Grout (from) II• (to)- - <br /> (2 I of Drilling nig type <br /> Pe---:ic No. Auger O.D. <br /> Completion - Scove pipe/chrstie box (circle one) <br /> Drlling Company: <br /> casing <br /> Drller: � �- : height <br /> Consuivunr <br /> Geologist " �`�-�-�O� ABCVSG.iCCNO \\C ' <br /> F GmS'IY-BCX <br /> =1104 <br /> Groc:nd StxtacL - -- <br /> 57FCi:L ?E: MIT INFO. <br /> 4ta'c <br /> Distance to sewer line 7 5 c) <br /> Dornes�c well on site - (y/ n) l3 !L <br /> if yes, location and distance - _jS g, <br /> — c <br /> — a <br /> Lar.id � y <br /> jA1l?UNG L�cdon — <br /> Fly$'padt <br /> :Holding Temperature <br /> Method '1'`'e' <br /> Screening Method <br /> Tracking Sheet - y n) �jS !f = T 3S' M <br /> S=OILS <br /> Storage e Method , S ` ^ L U"5 MA i_RIALS/Dh�LOP'.bCr-I <br /> Contamination Noced - y i n ) Z {�U C. <br /> Storage Locadon Olt �vt f Casing type <br /> Blank LI I fc Sceen 7,0 fe. <br /> Slot siz n LO <br /> GRCTJMNG Bags cement <br /> �7 i Buckets bentonire <br /> V l <br /> Depch to water Bags sand/gravel h <br /> Mix :Rados `/z — Filter Pack type/size � <br /> Iu:alla;on Method Surge Block: - (y n <br /> Quancry installed - o Discussed with geologist. - y n ) <br /> Type of method <br /> �1zz � � <br />