Laserfiche WebLink
MONITORING WELL INSTALLATION REPOn r <br /> Date:_ / c,✓ ZUDt/ CONSTRUCTION <br /> Premise Address:—� ��/ /jrJT /Z„ Total Depth 6 <br /> Screen Length (from) (to) <br /> Well No.: _ Filter Pack (from) L45 (to)_ <br /> Bentonite (from) (to) 1 <br /> Inspector: Grout (from) t (to) Q <br /> Drilling rig type <br /> Permit No. Auger D.D. 47 I.D. <br /> Drilling Company: <br /> Completion - Stove pipe/christie box Circle one) <br /> . 1146Z5 <br /> Driller: - Gt�C <br /> casing <br /> �� height <br /> Consultant <br /> Geologist <br /> ABO VE-GROUND <br /> COMPLETIatV C�iFilSTY <br /> CN <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer lined ' 7 boa 0{O <br /> Domestic well on site - n ) <br /> If yes, location and distance - <br /> r 4 <br /> SAMPLING C1. � <br /> Holding Temperature � 17_0 &I Pack <br /> _ <br /> Method <br /> Screening Method <br /> Tracking Sheet -E�n ) <br /> SPOILS <br /> Storage Method 5- MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) �r/ }/c <br /> Storage Location Casing type !/ <br /> Blank ft. Screen_ __ft• <br /> Slot size . O <br /> GROUTING Bags cement X0 <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/si e 3 <br /> Installation Method Surge Block: - n ) <br /> Quantity Installed Discussed with ge ogist: -(Ey) <br /> n ) <br /> Type of method V <br /> EH 29 29 <br />