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viol �Z[�iG W. :.r..I�iS►?L'..�;CCN R oaRT <br /> �1 7" �� coNs�ucTloN <br /> Date: <br /> Total Depth to <br /> P-esse Address: �' Sceez Length (from) <br /> ( ) <br /> /2� a Filter?ad,. (from) (to) <br /> well No.: Bentonite (from) <br /> Grout e6XAAA-tXfrom)�, - ----- <br /> Inspectoc: Dulling lig type <br /> 2i! 7i Auger O.D. I.D. <br /> ?err.:ic No. Comoletioa- Stove pipe/chrstie box (circle one) <br /> Drilling. Company. U�� 1 cas,nq <br /> ♦ height <br /> Dr11er: <br /> VV <br /> Consultant �"- <br /> Geologist�V .t3CY��RCL'ND ���X <br /> CrM?'=�;CN <br /> cuv=d s6TIacs �. <br /> cC,AT otR bQT I�iFO. <br /> S?_ prat <br /> Distanct to sewer line ---;7--'-t' <br /> Domesdc well on site - C Y/95— A. <br /> tt <br /> if yes, location and distance - ._..—..n• r- <br /> :rte - • <br /> sacion _ <br /> SANPLIVG <br /> Floldi.-:g.Tempera=— <br /> Method <br /> Scr!tning Method 20 j <br /> Tr ac`.cing Sheet - C Y n) �.--`�• ' — <br /> SPOILS <br /> Storage Method MA-1:RIALS/DEVET OPNSNI ' <br /> Contamination Note - C Y/ n) 2,t <br /> Storage Locadon Casing ryFe —�• <br /> Blest ft. Steen l <br /> Slot size <br /> „p To <br /> GRO ANG Bags ceme--nc <br /> g , Buckets bentonite <br /> Dench to water '" Bags sand/gravel 3 3 <br /> vii.Y Rados �x-�-+�-� Filter Patti type/size /Z <br /> Installation Method ���' Surge Mock. - (� a) '�� <br /> Quantiy Installed Type <br /> with geologic, - 6J n)qP't � <br /> Type of method "74� Ac <br />