Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to)_ <br /> Well No.: — Filter pact., (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: <br /> ir--, casing <br /> height <br /> Consultant <br /> Geologist <br /> ABCVE-GRCJND <br /> COMPLETION CI-R STY-&OX <br /> SPECIAL PERMIT INFO. COMPLETION Stziace <br /> Distance to sewer line arm <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ft. <br /> = m <br /> — o <br /> _= m <br /> SAMPLING = o <br /> SICtted — c <br /> sac�on = '+ <br /> Holding Temperature — <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n ) _ <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/n ) <br /> Storage Location Casing type <br /> Blank ft. 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 />