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rtD� RING Yr [tiST.A�-\:LCN IEPORT <br /> LI • <br /> /� - 3 coN_ s�uc rtocr <br /> Dais : / n <br /> U � /� , CX1La.�v Total Depth 23 <br /> ?remise Address: Sce_a [ eagth Cfrom) Z3 (to) S3 <br /> m6dFilter pack (from) Z3IIIIIINI Ro) 4� <br /> 'Noll fon: 3Lntanite (from) IIII `� OINIIIININ(to) <br /> Grout (From) <br /> Insaec:ac iii tt� DnUing rig type S <br /> �� �"D / 33 / Auger O .D .s <br /> i Pe_r;: iC NO. COmOIGQOn - SCOVe pive/6� !sd. 170Y (circle one) <br /> Drlltng Company. �il/ t��JGLC(�l casing <br /> ..� ♦ height <br /> �� <br /> Corsulcant /i � <br /> �t fJ , , , a,' , cv�3ACk ND cHSM !•acx <br /> Geologist �/`-' � <br /> I �V� c. <br /> S�>n <br /> sa _ . _itiaT tN�o. gran <br /> Distance co sewer tine 7 Jd <br /> Domescc 'Neil on site • C Y /(" AL <br /> lE yes, location and distance • 53 n• <br /> rAN <br /> = <br /> I -MOMP 3 <br /> 41M,49 I <br /> t*c-'on -IsIIIN <br /> maImom <br /> 3 <br /> j �j/t?!iNG <br /> Cr+ i <br /> HoldingTempera <br /> Ylture <br /> e=od <br /> Sceening �terhod / 7 � _ <br /> Tc-acci:.g Sheet - :L <br /> S?OILS <br /> g Oil k u KLlGt �L09 X41 7lALS/DEVELOPNENT <br /> Scorn i Method <br /> Contamination Noted - ( Y Casing type P ✓C <br /> Scocage Location �I a 3laa� 3 EL Sc_en Ly —m <br /> Sloc size o Z <br /> GSRO U 70 NG 3ags cement / n <br /> Buckets benconite�� T <br /> _ Bags =d/gravel 5 <br /> Depot to ONacer Filter ?ae.'c we/ a At, <br /> NALC :Udos � O p 'Y l� f 3% 33,LL.S <br /> Surge 3loc.'c • � a ) <br /> Installacon Aec a Ly� 1� Discussed 'Niu4 geologic• n ) <br /> Quant:/ Installed c Type of Method C° 4/ tiBO� f� NON <br /> e <br /> l � 5 93 <br />