Laserfiche WebLink
MONrrORING WELL INSTALLATION REP-e-r <br /> Date:—S.0 A-2 !' r ` L -- CONSTRUCTION <br /> Premise Address: 'T C7 V L L 1 O Total Depth so <br /> Screen Length (from)_�� <br /> Well No.: S Filter Pack (from) _3 -:) (to) / z <br /> Bentonite (from)_ -x(to) ! l <br /> [n ector. Grout (from) (to) <br /> sP Drilling rig type <br /> Auger O.D. 1•D• <br /> Permit No. , Completion - S ve pipe/cnrisde box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller. r Fr <br /> 7— heighc <br /> 7 <br /> Consultant <br /> c VI Geologsst n , f �y`„gCUND �LS��x <br /> 1 CrWL cTiCN COMPL=LICN <br /> SPECIAL PERMIT INFO. <br /> i <br /> Trout <br /> Distance to sewer line • <br /> Domestic well on site - ( y/ a ) P '�- <br /> If yes, location and distance - ftL <br /> SAMPLING l7I^l3 sbaaa _ j <br /> N <br /> Holding Temperatures = x+"•[Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - C y/ n ) �A4 LO�t nnQ W y! <br /> l( SQA <br /> spolLs <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ a) <br /> Storage Location �" Casing type <br /> �O 301 Blank fn Screen ft. <br /> bSlot size © 7 <br /> GROUTING e�?CQ Bags cement <br /> t Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios F7ter Pack typeJsiz <br /> Installation Method W urge Block: - (y en�Quantity��ed Ducussed with geon) <br /> r, .Type of method <br /> EH 2929 �Viy <br /> �5 <br />