Laserfiche WebLink
MONITORING WELL INSTALLATION REI -T <br /> • . <br /> Date: l g CONSTRUCTION - <br /> 4 <br /> 1 J r <br />+`r Premise Address: Tota[ Depth <br /> 4., a.. Screen Length( from) (to) <br /> Well No.: �W�11 �`f Filter Pack (from) (to) <br /> Bentonite (front) (to) ' <br /> Inspector. Grout (from) (to) <br /> I Drilling $'ri type <br /> Permit No. Auger O.D. <br /> Completion - Stove pipe/czuistie box (circle one) <br /> Drilling Company: <br /> Driller. casing <br /> T `Ye' hr <br /> Y� 7 <br /> Consultant <br /> y <br /> Geologist <br /> ABCVE-GRO(JNO <br /> CHS 4—I le-BOX <br /> IvQ?S'C'AN COMPL i ICN <br /> SPECIAL PERMIT [NFO. – - G=nd'Sulac* <br /> Distance to sewer line _ n <br /> Domestic well on site - ( y/ a ) - <br /> ff yes, location and distance - k L <br /> a <br /> a I <br /> SAMPLING aia[Rd — c <br /> Holding Temperature 7XV91 Pack <br /> Methodw — <br /> Screening Method <br /> Tracking Sheet - ( y/ n} r <br /> tL i <br /> SPOILS <br /> Storage Method MA'IERIALS/DEVELOPN ENT <br /> Contamination Noted - (y/ n } <br /> Storage Location Casing type <br /> r Blank fG Steen fr <br /> Slot size <br /> GROLYTING Bags cement <br /> Bur-leets bentonite <br /> Depth to water Bags sand/gravei <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Bloc-1- - C y/ n ) <br /> Quantity Installed Discussed with geologist: - C y <br /> Type of method <br /> EH 29 29 <br /> .i <br />