Laserfiche WebLink
lilt <br /> WELL INSTALLATION REPO s <br /> > ': <br /> Date: _ .�, �•. CONSTRUCTION ..� , N.,.,,z <br /> Premise Address: i ¢. -,.,. Total Depth <br /> Screen Length (from) (to) + F <br /> Well No.: ;: <br /> :��~ - . Filter Pack (from) (to) ! <br /> Bentonite (from) (to)' <br /> Inspector. ''° �. Grout (from) j (to) s� <br /> Y a x o Drilling rig type Gi <br /> Permit No. ry :, F. ;� Auger O.D. T.D. I <br /> Completion - Stove pipe/clu istie box (circle one) <br /> Drilling Company: <br /> Driller: #'. t 4 x casing <br /> .. ' he;ght <br /> L'.011sulCanL <br /> Geologist <br /> +t; i AWVE-GRCUNQ <br /> COMPLETIQN CHR�STY-84X <br /> SPECIAL PERMIT INFO. '� * . COMPL.RICN <br /> r `. � '� Ground Surface <br /> Distance to sewer line <br /> Domestic well on site - (y/n) }`a"''' Y , <br /> If yes, location and distance - �`,..�.""—"ft° <br /> SAMPLING ;Icroi c <br /> --if!,lkw .. <br /> socIcn I <br /> Holding Temperature <br /> Method -�; F' . _ y�rarrdPal* ;, <br /> Screening Method <br /> Tracking Sheet - (y/ n <br /> SPOILS <br /> Storage Method MATERIALS(DEVEI:OPMENT y <br /> Contamination Noted - (y/ n} ,� <br /> Storage Location Casing type <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement !'! <br /> Buckets bentonite �! <br /> Depth to watery .: Bags sand/gravel i # <br /> Mix Ratios :."'Jf' ui Filter Pack type/size <br /> Installation Method LL ,. Surge Block: - (y/ a ) <br /> Quantity Installed Discussed with geologist: y/ n } +, <br /> rip Type of method <br /> EH 29 29 <br /> t <br />