Laserfiche WebLink
_l <br /> 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) (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: _ '� casing <br /> 4 <br /> Consultant i height <br /> Geologist <br /> ASOVE-GROUND 17irT <br /> COMPLETION CHR iM_80X <br /> SPECIAL PERMIT INFO. COMPLETION <br /> (around Surfac4 <br /> Distance to sewer line _ 0r <br /> oul <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - <br /> ft. <br /> — a <br /> SAMPLING = o <br /> sbtted — c <br /> •acton — <br /> Holding Temperature — <br /> Method = pnv94 pack <br /> Screening Method _— <br /> Tracking Sheet - (y/ n ) _ <br /> SPOILS <br /> Storage Method M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank fr. 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 /> EH 29 29 Type of method <br />