Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT P I � r! 1-7 <br /> H 67 <br /> 71, T <br /> Date: �p ` CONSTRUCTION <br /> Premise Address: -7 3 oZ3 ! <br /> Total Depth <br /> Well No.: 4 Screen Length (from) _(to)� <br /> Filter Pack (from) (to) <br /> Inspector: Bentonite (from) f (o (to) R <br /> rj Grout (from) —(to) I <br /> Drilling rig type <br /> Permit No. Auger O.D. -,,2 I.D. <br /> Drilling Company:_ ris <br /> Completion - Stove pipe -�ie-$�x' (circle one) <br /> l� �D � A1\ <br /> Driller: <br /> casing <br /> n height <br /> Consultant ►'[ <br /> Geologist t �� $„- ,_ <br /> ABOVE-GROUND <br /> COWFLET{ON c4iR18T wx <br /> SPECIAL PERMIT INFO. Ground Surixs COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) l ft <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> SAMPLING = C <br /> 0 <br /> sloaed <br /> soon F� — <br /> Holding Temperature <br /> Method vivo'P-<�k <br /> Screening Method <br /> Tracking Sheet - (y/ n ) . <br /> L; <br /> ft. > tt <br /> SPOILS <br /> Storage Method 4ML MATERIALS/DEVELOPMENT <br /> Contamination Noted - y/ n )� it Storage <br /> type <br /> r� P <br /> Storage Location /a-� Casin e a <br /> Blank ft. Screen <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 />