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 (from) (to) <br /> Inspector: Grout (from) <br /> (to) <br /> Drilling rig-type'' <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: _ 'Y casing <br /> Consultant height <br /> Geologist <br /> ABOVE-GROUND <br /> CCWLET10N CNR*'TY-$OX <br /> SPECIAL PERMIT INFO COMPLETION <br /> Ground Surface <br /> Distance to sewer line of <br /> Domestic well on site - (y/n ) <br /> rout <br /> If yes, location and distance <br /> ft. ft. <br /> = m <br /> m <br /> SAMPLING c <br /> alotted _ c <br /> Holding Temperature <br /> Method = F <br /> Screening Method <br /> Tracking Sheet - ( y/ n ) -- — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y/n ) - <br /> Storage Location <br /> Casing type <br /> Blank ft. Screen ft. <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> EH 29 29 Type of method <br />