Laserfiche WebLink
MONITORING WELL INSTALL&TION REPORT <br /> CONSTRUCTION <br /> Date: <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller":_,_ ,1 y height <br /> Consultant - <br /> Geologist ABOVE-GRMNO . X <br /> OOWP ET*N cota�t_rnc�a <br /> G=nd Sul <br /> SPECIAL PERMIT INFO. <br /> grart <br /> Distance to sewer line It. <br /> Domestic well on site - (y/ n) <br /> if yes, location and distance - ft' <br /> tt. <br /> act <br /> a <br /> SAMPLING io-cicn <br /> Holding Temperature <br /> Method °� <br /> Screening Method <br /> Tracking Shcet - (y/ n) n, <br /> SPOILS <br /> MATEMAj§ZDEVELOPMENT <br /> Storage Method <br /> Contamination Noted- (y/n) Casing type <br /> Storage LocatioScreen________—ft. <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/II) <br /> Jpstallation Method Discussed with geologist: - (y/ In ) <br /> Quantity Installed Type of method <br /> EH 29 29. <br />