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MQ roRING WE[I-INSI•AL3ATlON REPORT <br /> D'att: -OD CONS7RUCCTON <br /> premise Addrms X1/00 ��f Ym o w� Toal Depth -70 <br /> Screen Length Cfrom) -2o- Cto) <br /> Wel No_ raw Pack Mom) <br /> Beatoait CEom) !R Cro) <br /> Inspector. Oy Grout CL-om) ifn ' (to) <br /> Diming rig type - <br /> petmitNo: o cow AngerO.D. <br /> ATG. Comoletion- Stove pine/christie box (circle one) <br /> Dulling Company /�l/�Gl r� i- <br /> casLa4 - <br /> 30-VO it i <br /> cousuluat Al£ r <br /> Cvologir., _ Jl'r^vS�ADC.'C!D CHFSY3CX <br /> ��Cr-�S Sc-.•aer - <br /> SPECIAL PERMIT 7NFC- i <br /> gr o= <br /> Distance to sewer lin- VfL <br /> Domestic weL on site - C Y/F3) <br /> if yes,la¢doa and distance - ;t, 1 - = <br /> _ o <br /> Iii UNG iiCO6 <br /> Holding Temperature <br /> Method n — <br /> screening Method Oi O <br /> Tracking Sheet - l�/ a) - — ♦ <br /> SPQR S <br /> Storage <br /> MgTERIAyS/DEVELOPMENC <br /> Cona=iMarion Noted - C Y/a) Casing type PVC a 'r <br /> Storage Location Blank �� $ SQeen Za —fr- <br /> Slot size '�O <br /> GFiOL'IiNG Bags cement 8 <br /> Buckets bentonite / 6 <br /> DGDdl to water N sa-� Bags rand/graveI l' <br /> bGx Rados Filter Pack Me/size <br /> lnsulladoa Method �* �-4-j' k2� c�i � Sege Block: - C�5=) <br /> QU=hty Discussed with geologist - C a <br /> Type of method- Rod <br />