Laserfiche WebLink
'MONITORING WELL INSTALLATION REPOiFt I'" <br /> Date: CONSTRUCTION <br /> �/! N l <br /> Premise Address: Total Depth 0Screen Length (from) (to) S O <br /> VT.fJ- 3 Filter Pack (from) n (to <br /> Well No.: ) <br /> Bentonite {from} (to) <br /> Grout (from} (to) <br /> Inspector: __4 ZS <br /> Drilling rig type <br /> Permit No. 7Y Auger O.D. LD• <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant r <br /> Geologist � - AE&E-GROUND <br /> COMPLETION *TY-SOX <br /> C <br /> SPECIAL PERMIT INFO. Ground Surface <br /> ? grout <br /> Distance to sewer line <br /> Domestic well on site - y�I n ) <br /> If yes, location and distance - ft. <br /> .ie A <br /> w' C <br /> SAMPLING slotted := c <br /> l aeclon "l <br /> Holding Temperature71 p <br /> Method } - <br /> Screening Method V _— <br /> Tracking Sheet - {y/n ) <br /> SPOILS <br /> Storage Method J� U�.�( MATERIALS/DEVELOPMENT <br /> Contamination Noted - y } �ft /)�e <br /> Storage Location Casing type <br /> Blank 5 U Screen <br /> SIot size_ 4 <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water— = Sb Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y n <br /> Quantity Installed Discussed with geo ogist: - (y/n } <br /> Type of method <br /> EH 29 29 <br /> 7 <br />