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MOS ')RING We-,L.L INSiALJ_-k17ON R`aORT <br /> CONS7RU=ON <br /> Adress: Depth <br /> 3�- <br /> Screen Lengrh (from) (to) <br /> Well No.: _ Filter Pack (from)_ (to) Z3 <br /> Bentonire (from) Z (to) Z TM <br /> Insaec:ar. Grout (from) 2t• (to) <br /> Drilling rig We <br /> ?/ 7/ Auger O.D. I.D. <br /> Permit No. ... , . o . <br /> Compledon - Stove pipe/chrstie box (circle one) r <br /> Drilling Company: <br /> casing <br /> Driller - . - : . fight <br /> Cansultanr S <br /> i <br /> Geologist --. � . �VB-G�Ct;HD. :, -C_G*6 _8CX ' <br /> CCP.�r'�=i fCN C:MP!=i ICN <br /> Sperlar ?ER2MIT INFO. I <br /> Dista.-ice to sewer line �) - <br /> Domescc we-11 on site - (y n) v - - <br /> If,yes, location and distance - - <br /> ShMPL�NG <br /> ¢xvai pad; s <br /> Holding Temp _— <br /> Met,`+od W. '�P <br /> Screening Method 4 7A. <br /> _ $. <br /> TrSheer y n ) '~ ,gym 7 x = - it <br /> ��.. <br /> SPOIIS -,. <br /> �W Y <br /> Storage Method ti ' M.A1-RIMS EVYrLOPNENT N- <br /> tt 4 x k <br /> y §� <br /> Contamination Noted - { y n y , Sa 46 <br /> Storage location U Castng type E <br /> / Blank fr- Screen �- <br /> Slot size U Z <br /> GROUTING Bags cemenr y <br /> r 4 Buckets benronite a <br /> Depth to water2 - Bags sand/gravel - "3-* - ; <br /> girlie patios -~ Filter Pack We./size ' # c.S <br /> Ins;allatian Met.'zo -t -- Surge Block. - n) <br /> Quanr'ry Installed .�_ -M� �. Discussed with gealo 'st: • (y n ) <br /> ,. .. _.. <br /> ethod <br /> Type of m <br /> - .k .. z .. ..wa._.iN. - •N 4i -, w m w_ -. --'I +[ — --k s ... w .. dµ' •P .- <br />