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mat NG W_' INSTAL—' A:ICN REPORT • <br /> yt rr /l IZY� CON�ON <br /> Date: lg <br /> Total Depth <br /> ?-emise Address: 7��` Seeea Le^.gtb <br /> Flter Pack (from) <br /> Weil No.: Bzntonite Cfrom) 7 (to) <br /> Grout <br /> [nspec:or. Q / Drilling rig type �- <br /> �_�!b�1� Auger O.D. <br /> ?e^it No. Comole 'on- Stove pipdc ^'s a box (circle one) <br /> Dr1ing Company, cas, 9 <br /> � - T / ♦I� he_5h <br /> Consultant Lilr ' 7 �/✓i <br /> �� �lD�odio �3%Y�vRLX,TID - C}iR5"!3CX • <br /> Geologis M?'-F7SCN Cc,A{p- 1CN <br /> Groond . <br /> i <br /> SPcrjat PcRNUT 1N=0. Orwt <br /> Distance to sewer IL^.e V <br /> Domestic well on site - (y <br /> if yes, location and distance - �n• <br /> :c' c <br /> _ o <br /> ibRnE <br /> t*con r, <br /> holdi..g Temperature <br /> Screening *no <br /> Tradking Sheet - n) <br /> SPOILS <br /> '/ MA i=RIALS/DE�'LOP?�"r <br /> Storage Viethod <br /> Con.amination Noted - C y n ) / / Casing type —=_fy <br /> Stoage Locations�-P`� glya c J ft SceeZ <br /> Slot size �L <br /> Bags cement <br /> GROU:LNG Bu6w:s bentonim ( � Z� <br /> Bags saad/gravei 6 �_ <br /> Deoth to water �7 filter Pack typdsize 3 <br /> NIL Y Raaos Surge Bloct: - C y/ a) <br /> lnstallacon Method Discussed with geologise - ( y/ n) <br /> Quantity installed Type of method <br />