Laserfiche WebLink
I <br /> WE OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date:-- D`~ 15 C� CONSTRUCTION <br /> Premise Ad ress:C/`f S � Pd., Well No. in <br /> Inspector: ��r �, e�`, Total Depth <br /> Screen Length <br /> Filter Pack <br /> Bentonite Pellets <br /> Permit No. C�-�3� c� Grout <br /> Consultant f s J� sum . Completion-Stove pipe/christie box <br /> Geologist -C . , t: <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING ------ - _—_ <br /> Holding Temperature stick-up <br /> Method <br /> Screening Method 11 <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> grout <br /> Storage Method <br /> Contamination Noted - yes/no n• <br /> Storage Location n• <br /> ft. <br /> = a <br /> SPECIAL PERMIT INFO. — <br /> 0 <br /> Blotted — c <br /> Distance to sewer line on _ $ <br /> Domestic well on site - yes/no _ gravel pack <br /> If yes, location & distance - <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water '� 3 o Casing type <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />