Laserfiche WebLink
~ • JOGE / OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: .� J / CONSTRUCTION <br /> Premise Address:_���Y � ���� Well No. /-✓ OZ <br /> Inspector: Total Dept <br /> Screen Length �/f•S- L ,S ' <br /> Filter Pack y/�. - Z S_ <br /> Bentonite Pellets-,2 7 <br /> Permit No. Grout 7 - / <br /> Consultant Completion-Stove pip chriatie box <br /> Geologist © /� <br /> Auger O.D. <br /> Auger I.D. G <br /> SAMPLING ,// <br /> Holding Temperature /kc U/ stick-up <br /> Method <br /> Screening Method / <br /> ABOVE-0ROUND CHRIS1Y-BOX <br /> Tracking Sheet (y COMPLETION COMPLETION <br /> SPOILS �— Surface + <br /> / proal <br /> 7Storage Method G, _,1 G��� �Y14��� 1 <br /> Contamination Noted - yesa <br /> Storage L caj:ion _ n' <br /> - m <br /> SPECIAL PERMIT INFO. <br /> o <br /> Hotted = c <br /> Distance to sewer li ek;pop - = <br /> Domestic well on site - yes o = graveiPack <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing typey <br /> Mix Ratios Blank— ft. Screen ZD ft. <br /> Installation Method Slot size d Z y <br /> Quantity Installed Bags cement <br /> Buckets bentonite— <br /> Bags sand/gravel /O <br /> Filter Pack type/aize _-� Z <br /> Total Billed Time Per Site (0hrsp®`�S/�� <br /> Date Permit Finalized < ' 3 � /�/ <br />