Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: _ CONSTRUCIION <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: <br /> casing <br /> Consultant height <br /> Geologist _ T <br /> ABOVE-GROUND <br /> COMP LET IC N CNA ISTYW X <br /> SPECIAL PERMIT INFO. COMPLETION <br /> Ground Surf ave <br /> Distance to sewer line orout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - ft. <br /> ft. <br /> a <br /> = m <br /> b <br /> SAMPLING _ o <br /> s to a.d c <br /> aoc�on = 2 <br /> Holding Temperature I— <br /> Method = g-vq�PaCR <br /> Screening Method <br /> Tracking Sheet ( y/ n ) <br /> _ h. <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 />