Laserfiche WebLink
L.iONITORING WELL INSTALLATION REPU.J <br /> Date: L CONSMM—bllON\ <br /> Premise Address: f _ 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 /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: <br /> height <br /> Consultant 7.5 <br /> Geologist AE&E-GROUND CHAMTY.gpX <br /> COMPLEflCN COMPLETION <br /> SPECIAL PERMIT INFO. Ground StAtact <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y! n ) ft. <br /> If yes, location and distance - ft. <br /> ..__ft. <br /> 4. m <br /> _ m <br /> C <br /> 0 <br /> SAMPLING slatted ` <br /> secdon <br /> Holding Temperature = prsval pack <br /> Method O&A <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 €t. <br /> rR Slot size <br /> GROUTING Bags Bags cement <br /> 4f Buckets bentonite <br /> Depth to water 416 --(,--, 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 /> Type of method <br /> EH 29 29 <br />