Laserfiche WebLink
• MONITORING WELL INSTALLATION OORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from)' (to) <br /> Well No.: Filter Pack (from) (to) <br /> Inspector: ' <br /> Bentonite' (from) (to) <br /> Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion- Stove pipe/lil tie box (circle one) <br /> Driller: casing <br /> Consultant ,� height ' <br /> Geologist �• <br /> ABOVE-GFOUND <br /> CO W LET}ON C4iA1M430X <br /> SPECIAL PERMIT INFO. aCOMPLETION <br /> round Surfxa <br /> Distance to sewer line ora t <br /> Domestic well on site • (y/n) <br /> If yes, location and distance - ft, <br /> — m <br /> SAMPLING c <br /> tlottnd <br /> wcdon <br /> Holding Temperature — <br /> Method = pnv&i pack <br /> Screening Method <br /> Tracking Sheet y n — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted- (y/n) <br /> Storage Location Casing type <br /> Blank ft. Screen g• <br /> GROIT TNG Slot size <br /> Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method ____.�yarge_Block: - (_y_/_n.) <br /> Quantity Installed Discussed with geologist: - (y/n ) <br /> EH 29 29 Type of method <br />