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• �.�Ca yr 9-[�i n� // °�n..., — .Jv%/ ry cl�wr <br /> u i ` MotTO <br /> RING WE:L II15IAL ALON R—ORT <br /> Dare. �!y�9 CONSTRUCTION <br /> p-exist Address- <br /> �6d GJ .r Total Depen S <br /> ?p�u' Sw - 3„ -,c Screen L=gdt (from) l,S (to) 30 <br /> Flrc•pack (from) r (m) ��— <br /> Well No Bervt=r. (frOM) (to) 3 b <br /> Grout (from) .,44, (to) S L114�11 <br /> Iaspe=r. DcUing:ig 7De <br /> Anger C.D. <br /> pe. it No. (:attrpiedon- Stow pipe/chri-Sde box (circle one) <br /> Dnamg Co=Danv, / �vn2i <br /> DTlller. 7�MA d �' 9ir7 G7 aC t- <br /> Coasilani �' �7'sy v _ <br /> Geologist 0 (�ir A3�vU-AGUNp <br /> r/ GI.P'=i..N •,�,trSP=:CCN <br /> SPECIAL p RRM11 TIT'O. Crs�_-: s�rt��]o - <br /> Distance to sewer line <br /> Domestic well oa sire - C y/ n ) a-7 ` <br /> L`yes, location and aisazce - <br />;' L\\ slocad - <br /> SAmPT IN G Otto,k' as �J _ 3 <br /> sac= <br /> Holding <br /> — <br /> Holdtng Tempe:an:re �1 G — 7z1W Pal= <br /> Me=od = -t <br /> Scerxing Method--./' (� <br /> Tracking Sheet: - C 9/ a) <br /> /U�,I� - d� 30 =/uo <br /> SAOIIS Yom, 35-=/OO <br /> jrulrn.I '& rd Y,&-) <br /> StorageMethod MATM- ALS/DEVW—T OFTEN- S c Y'e o ) _\ <br /> Conmminarion Noted - (y/ a) vL ' <br /> LZ <br /> Storage Location �S C <br /> prn� 7 3latrk <br /> Sloc si= <br /> GROUTLNG l <br /> Bags <br /> Depth to ware- Bags sand/ c <br /> Mia Ratios rtlrer pack ype/=e <br /> incaltarion Method Sorge Blocie - C(y, <br /> Qoanriry[asmiled Discussed with geology - C(i <br /> Type of merhod <br /> Eli 29 29 <br /> nz� a-zlu -tom..,(/. <br />