Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> i <br /> Date: ' ��1 r 1 CONSTRUCTION <br /> i <br /> Premise Address:? J ' <br /> ( �• ��"� �'�'`� Total Depth V f^,111(N <br /> Well No.: / �C` AV431/M Ii fl`5Cj 4cA Lle- il�e ack gth(from) -(to) <br /> Bentonite (from) (to) <br /> Inspector: �L_!.�(iwy ( 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 /> Driller: casing <br /> (s � height <br /> Consultant <br /> Geologist :f�wt_f �. <br /> 1lSOVE-GROUND CtiFiISTY-80X <br /> CSM?LETION COMPLETION <br /> SPECIAL PERMIT INFO. Ground gudwe <br /> Distance to sewer line /�(� pout <br /> Domestic well on site - (y/n ) <br /> If yes, location and distance - ;- ft• <br /> .r..'E..._ft. 14? ft. <br /> - O <br /> SAMPLINGslonw <br /> 6 aacdon — <br /> Holding Temperature = . <br /> Method <a _ gMVW pads <br /> - <br /> Screening Method <br /> Tracking Sheet - (y/n4.) <br /> __ft. <br /> SPOILS <br /> Storage Method C-1�1 M_ ATERIALS/DEVELOPMENT <br /> Contamination Noted - (Y/-n <br /> ) <br /> Storage Location_`Z'"- ;6t ,, ' <� -'`�� Casing ?e , h> <br /> V Blank `s U ft. Screen <br /> Slot size—r-?"i <br /> GROUTING <br /> ize r- <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gnvel_ <br /> Mix Ratios L.L/( Filter Pack type/size <br /> Installation Method t"1 L .cy' Surge Block: - Cy / n ) <br /> Quantity Installed Discussed with geologist: - <br /> Type of method <br /> EH 29 29 <br />