Laserfiche WebLink
MONITORING WELL INSTALLATION R H--eLT <br /> Dat, CONSTRUCTION <br /> Premise Address: ' ��lt STK Total Depth 1 <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) I (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 ipe/christie box (circle one) <br /> Drilling Company <br /> casing <br /> Driller. —�7 he?qhc <br /> 7 � <br /> Consultant <br /> f <br /> Geologist �`'" °`� A3cV=--;R0UN0 <br /> COMPL�,� CN <br /> SPECIAL PERMIT INFO. GDCtnd a" <br /> I- r <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - �- <br /> '.J <br /> 73 <br /> _ O <br /> a <br /> o <br /> SAMPLING iloaad <br /> saran _ <br /> �p o� <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y n ) <br /> SPOILS <br /> Storage Method N MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n <br /> Storage Location �U�" Casing type <br /> Blank ft. Screen <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 6 Bags sand/gravei <br /> Mix Ratios / Filter Pack type/size <br /> Installation Method Surge Block. - (y/ ) <br /> Quantity Installed Discussed with geo gist: - C Y/ a) <br /> Type of method <br /> EH 29 29 i <br />