Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <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 /> casing <br /> Driller height <br /> Consultant <br /> Geologist ABOVE-GFICUND <br /> CAh�F'LETfON C4 -s30X <br /> COWPLETICN <br /> SPECIAL PERMIT INFO. Gourd Sufaas <br /> Qrovt <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - ft• <br /> tt. <br /> V' » <br /> � X <br /> SAMPLING tlornd <br /> socicn <br /> Holding Temperature = <br /> Method =Y <br /> Screening Method <br /> Tracking Sheet - (y/ n) A _ <br /> ..ft.. = ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) Casing type <br /> Storage Location Blank ft Screen____--- -ft. <br /> Slot size - <br /> GROUTING Bags cement - — <br /> Buckets bentonite <br /> Depth to water Bags sand/gravcl <br /> Mix Ratios Filter Pack type/size <br /> - installation Method Surge Block: - (y/n ) <br /> Quantity Installed Discussed vrith geologist: - (y/ n) — <br /> Type of method <br /> EH 2?29 <br />