Laserfiche WebLink
GE i OF� <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: ��G�� Cf1'i�3 �."'C' Well No. <br /> Inspector• Total Depth �ZS <br /> 77 Screen Length 7�� `-/3 <br /> Filter Pack 'r <br /> Bentonite Pellets <br /> Permit No. GroutGiF l <br /> Consultant ✓ - Completion-Stove pipe�'christe box <br /> Geologist c,'c-/ ,L'/ ;7� ✓ <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature t ` stick-up <br /> Methodea <br /> Screening Method ._ <br /> ABOVE-GROUND CHRISTI'-BOX <br /> Tracking Sheet (y(n-)/ COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> grout i <br /> Storage Method C'I/ <br /> Contamination Noted - vO` /no <br /> Storage Location <br /> a <br /> SPECIAL PERMIT INFO. = c <br /> — o � <br /> r slotted — c <br /> Distance to sewer line section <br /> Domestic well on site - yes n = gravW <br /> If yes, location & distance - <br /> i <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water I ( Casing type <br /> Mix Ratios Blank ft. Screen 35 ft. <br /> Installation Method Slot size f Z <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />