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AwaMT01UNG 1f�PLL t <br /> ALLATION REPO <br /> a S-9''/ . <br /> 41vCONSTRUCrION <br /> Date: <br /> j �� Total Depth <br /> Premise Address:-- Screen Length (from) <br /> Filter Pack (from) <br /> Weil No.: Bentonite (from) (to) <br /> 1 Grout (from) (to) <br /> Inspector. ) <br /> Drilling rig type <br /> Auger O.D. IKLD. <br /> Permit No. Completion-Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: T height <br /> I <br /> Consultant (� T <br /> T <br /> Geologist AJFOv -GRCUNO <br /> COMlPI.ETiON C�tIS1Y-80X <br /> CQMPLEMON <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line Qrout <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - M <br /> ft. <br /> r � r <br /> SAMPLING <br /> sacticn <br /> Holding Temperature <br /> Method _ Pack <br /> Screening Method <br /> Tracking Sheet (y/ n ) 7 <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/n ) <br /> Storage Location Casing type <br /> BIank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water -S ,� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />