Laserfiche WebLink
�J <br /> M NITORING WELL INSTALLATION REPORT <br /> Date: l( CONSTRUCTION <br /> 4U <br /> Premise Address: 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 /> Driller: casing <br /> f IF heiCht • <br /> Consultant—I�Z�.t" -- � <br /> 7/4 <br /> Geologist <br /> ABOVE-GACUND CI•RZTY-BOX <br /> COMPl..Er10N COMPLETIC t <br /> SPECIAL PERMIT INFO. Gr=ound Surtses <br /> Distance to server line grout <br /> Domestic well on site - (y/ n} „'� ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> C <br /> d <br /> SAMPLING �Iornj <br /> +acicn <br /> Holding Temperature <br /> Method " — �Yot POCK <br /> Screening Method +' <br /> Tracking Sheet / n } <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n } <br /> Storage Location Casing type <br /> Blank ft Screen h• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water S " 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 />