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MO' BRING WELL INS-IiALL ZON REPORT <br /> Date: ., CONS'T'RUCTION � 9 <br /> Prem,se Address:�� A&Y' Total Depth 3 <br /> Screen Length (from) -CEO) Z <br /> Well No., �i .Cf3 . ., Filter Pack . (from) (to) Z 1� <br /> Bentonite Cfrom) g W-zl-fcto) zz. <br /> Ins3ector. ,. . Crout (from) 21 U • CEO) <br /> Drilling rig We <br /> Pe=it No. . -Auger O.D. I.D. <br /> Compleda pipe/chrsrie box (circle one) <br /> Delling Company: <br /> c a ;ng , <br /> Dellen hei ht <br /> . • 1 13, <br /> Consultant �'� - W' Dj <br /> Geologist ABOVS•-ARCUND - CHR kY-3CX ` <br /> C:.141P:_=i ICN <br /> 5PECTAL PERMT INFO, z <br /> w . groct _ .. . <br /> Distance to sewer line y f <br /> Dor:esdc well on site • 5/0 <br /> If yes, location and distance - <br /> Noldi,-lg Tempe e _ y <br /> Method ' <br /> .. �.. , _ ., x.r <br /> Screening Method 0✓ � _ <br /> Tractirtg Sheet n ) ..: �c� , • = n. <br /> --•�— F <br /> - l _V. , 4'. <br /> SPOILS t <br /> Storage Method MA t_RIALS EVELOPNENT � <br /> Contamination Noted - C Y 1 y' ! k Casing type"� b Y� � <br /> .K. � <br /> Storage Location Blank y fr- Screen l —. ft. <br /> `Slot size 'O ! <br /> GTtOEJ?tNG - Bags cement <br /> .�. <br /> Bur2kets bentonite r L <br /> Depth to water w . ° -Bags sand/gravel I s <br /> �I:.�t R. Ed �`` <br /> �, „- k Filte.*Pack type/ 'ze 3 LS <br /> installation Vl --- - Surge i31ock: • y n) <br /> Quantity Installed �~ Discussed with geologist: • ((y�r n} <br /> `%Type of method 2 �a-Kd <br /> r. - . ...+,..s-r-..ww'""!" -a.n .+wwfr+.« .. a w• r- ,. - ,r!ti .,.w. w. .s , v ., <br />