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VIOr �R.ING Wc._i.I.IN5"iAL:_.�;CN R oOIZT . <br /> CONSTRUCTION <br /> Date: <br /> �DO f. �i 54117— Total Depth <br /> ?-emise Address: Screen Length (from) /o O <br /> Filter?ad', Cfrom) a (to) 3 <br /> Weil No.: �� 3' #703 - Bentonite (from) (to) <br /> Grout Cfrom) ( -(to) O <br /> Inspector: Dulling rig We <br /> Alger O.D. I.D. <br /> ?e=,-;r No. �Dt S Completion- Stove pipe/czr'stie box (circle one) <br /> Drilling Company. casing <br /> he; <br /> v _ <br /> Consultant_4Z <br /> ,!� AacVE-GROUND Ct�Rra.Y-acX <br /> Geologist (/ Ort,?'=►fCN _ <br /> C�sr�d S�-:xs <br /> Sperrat pcR3e4T IN- -O. grout <br /> N1A- n <br /> Durance to sewer line 3 ;t- <br /> Domestic well on site - (y ����. <br /> Ii yes, location and distance - <br /> i <br /> tIOiS�d •tri _" i <br /> ��C:Ot1 r• — <br /> C <br /> Ijoldi^g Tem :re <br /> Method J <br /> Screer.ing Method =_= <br /> r fL <br /> Tracking Sheet - Y n) <br /> SPOILS <br /> e 1�Iethod CD2oC.ti l✓c.o MA 1:RIAIS/DEVET OpI�SN-7 <br /> Storag <br /> Contamination Noted - C y 49)) Casing tYPe <br /> Storage Location O� ��'` Blank fL Screen fL <br /> Slot size - Z' <br /> Bags ceme_zt <br /> CRS=NG Budtes bentonite <br /> Bags sand/gravel <br /> Depth to water t 3 rm, Filter?ack typdsize <br /> NIix Rados l t Surge Bloc-ti: - U n) 10 <br /> Insralladon Vietho �" Disc=sed with geolog;.= - n <br /> Quand:y installed Type of method <br /> 7 2-�� 1/*3 V/ 2, P 06 3 <br />