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k <br /> 7 - <br /> �lZ3 CONSl'RUC'I'ION . . ... , <br /> Date: . - v,_ A. F. j <br /> Premise Address: l W Total Depth - - <br /> Screen Length (from) ` v (to) <br /> Well No.: c <br /> Filter Pak - (From) <br /> Bentonite {from) <br /> Grout {From) (to) <br /> Inszec;or: <br /> �� Drilling rig type <br /> Fe:�tit X10.. �„... r _ Auger O.D. LD. <br /> Co 'a - ove piWchrstie box (circle one) r <br /> Drilling Company. <br /> T , asght ► <br /> Drller- - 3 r T °h i ht e <br /> Consultant t <br /> Geologist A3CYEvr IX1N CNRm4y_aCX <br /> r <br /> w Ground Sutxt <br /> _ - grout _ <br /> Dista^.ce to sewer line <br /> Domestic well on site - ( y/ <br /> if yes, location and distant <br /> SAyrnL(VG iac:on <br /> ... <br /> _ . ...w gm pact <br /> Foldirig T emperature /64-'t _ t <br /> Method <br /> Screening:Method � — <br /> Tr acting Sheet - n ) ' ti "�ft. 7�. K = r n, <br /> SPOILS - 7 '�. � �'�'m. ,. •�^ � ;;E.-.:, `i'�,,.. .' '� �, ' � 11 �• <br /> Storage Method �'Q y i R1ALS/DEVELOPIENC <br /> Contamination Noted - ( n) /{ <br /> Storage Location Casing type Ste` <br /> �� -Blank ft Screen <br /> G�.td'u wd Sior'size <br /> GPLOLMNGw e Bags cement <br /> Buckets bentonite' ' <br /> Dept<`t to water ?/ Bags sand/gravel <br /> ' x Ratios �' = w" Fdte_r Pack type! ' <br /> Sure Block: - <br /> fns:alIation Vlet:'�od - x "_ "` g Y . <br /> Quantiy'InsraIled y z Discussed with ologisr. - / n) <br /> ._ w . .. . - -*°-•Type of method L <br /> 6 <br />