Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from)-(to)- <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector: Grout (from)-(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist _ <br /> ABOVEGROUND <br /> CC&FLET10N Ct6iISiY-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line gram <br /> Domestic well on site - ( y/n ) <br /> If yes, location and distance - <br /> ft. <br /> tt. <br /> O <br /> 0 <br /> C <br /> SAMPLING &iah*d _ 8 <br /> &*clan <br /> Holding Temperature <br /> Method j71VW Pack <br /> Screening Method = <br /> Tracking Sheet - (y/ n ) <br /> tt <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 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 />