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V[C��RI G W'—El INIAL-1 -%i1CN Rr�CRT <br /> Date: CONS MUCitON <br /> • � _ <br /> ?remise Address: �' 1/�2 Tow Depn`t <br /> l//!(/�/ / Seen Le.^.g[.�t (h'om) ([o) 4925y -17� <br /> ___ <br /> Well No.: - -_ <br /> Filter !Pack (from) �16 (co) <br /> Bentonite (from) V, --(to) <br /> [nsoec:or. .5 Grout {Pram) -AW -z ' (to) MLqlf <br /> 7 A� Drilling rig type 3 <br /> °e^it No. <br /> a ([j Auger O.D. f- <br /> Campledoa - Stove pip zrstie box :role one) <br /> Dr-T.ing Company" <br /> casing <br /> Drrrer ♦� ' he_ghL <br /> cors:lra.^.c' �/-du.I <br /> Gealo st d A9cvS-GrICc:ND �\ <br /> CHFALS'IY-3cx <br /> G=nd Stu'lacs A <br /> 52�Ci�r ?ERMIT INFO. i <br /> gtat <br /> Distance to sewer line i <br /> Dor:+esuc weii on site - ( y/ n) _fL <br /> I[yes, location and distance - � . <br /> 3 <br /> O <br /> aforrad <br /> SA-MPUNG taccn �: <br /> rack <br /> Holding Temoerature P1:1 <br /> Method : RE <br /> Sc:eening Method <br /> Tracking Sheet - (y/ n ) fto4t. <br /> SPOILIS _� <br /> Storage Method / /� �%�"�ri`-� MA 1 RIALS/DEVEr ORNSN t' <br /> Contamination Noted y n <br /> Storage Location Casing type <br /> B1an3�S'` fit{ Sceez YD S_E-� <br /> Sloc size e D Z o <br /> GROUTING Bags cemenc <br /> r Bucker bentonite / <br /> Deota4 to ware: Bags sand/g.-av o, z of <br /> M,c Rados Filter Pack rype/size <br /> Iastallat'.on V[e oil dP — Surae BIock: - {;• <br /> Quand,-j Installed Discussed with geologist: -j/ a ) <br /> Type of method <br />