Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: / Al CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: A -W 7, T1V C4Filter Pack (from) (to) <br /> p/ 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 /> height <br /> Consultant Cf_� T <br /> GQingi is –1A in,I <br /> Ai&rz-GROUND <br /> COMPLETION CNRtm-80X <br /> COMPLETION <br /> SPECIAL PERMIT INFO. (end Surface .�. <br /> Distance to sewer line gra <br /> Domestic well on site - (y/n <br /> If yes, location and distance - <br /> _ ft. <br /> ft. <br /> s,= q <br /> SAMPLING = <br /> slotted � <br /> wcaon <br /> Holding Temperature _ P <br /> ack <br /> Method — <br /> Screening Method : - <br /> Tracking Sheet - (y/n) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - {y/n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 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 />