Laserfiche WebLink
�� i <br /> 4�MONITOR m WELL INSTALL�ITION REP K. <br /> 3 CONSTRUCTION <br /> Date: ��,�p ��F <br /> Premise Address:_ � � � ` '� Total Depth <br /> �n Screen Length (from) 20 (to) S <br /> Well No.: r J Filter Pack (from) 2 ( (to)�_ <br /> Bentonite (from) (to) —3 <br /> Inspector. Grout (from) oto) 5-LAMcxCQ <br /> V �O � � � ✓ Drilling rig type o � i' - <br /> Permit No. Auger O.D. I.D. <br /> _ ` Vj Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: �i n Q�/ <br /> Driller - l� n casing <br /> 7 � height <br /> Consultant 7 <br /> �y,r� a�- ice- � <br /> Geologist IIBCVS-GFt0UNG d-SiSC`f X <br /> SPECIAL PERMIT INFO. Card Sutacs <br /> Distance to sewer line <br /> Domestic well on site - {y 'y ft. <br /> If,yes, location and distance It <br /> r <br /> SAMPLING <br /> Holding Temperature ` I = _ 71tvvi Pack <br /> Method t S 5 S i►e'� �" <br /> Screening Method <br /> Tracking Sheet - { y/ n) <br /> a� <br /> SPOILS <br /> Storage Method �r(�i� MATERIALS EVELOP?y1E T <br /> Contamination Noted (Y)/ nVc— <br /> Storage Location SI I C — Casing type <br /> Blank ft. Screen <br /> Slot size 2 <br /> GROUTING Bags cement <br /> r� r f�b , Buckets bentonite <br /> Depth to water ( Bags sand/gravel_ S <br /> Mix Ratios Filter Pack type/ e <br /> Installation Method Surge Block: (y,/ n ) <br /> Quantity Installed Discussed wi ologist: (Y/ a) <br /> Type of method <br /> EH 29 29 <br /> J <br />