Laserfiche WebLink
53 <br /> MO INSTALLATION RE. .T <br /> 7 � <br /> Date: T(W-,OII CONS UCTION <br /> Premise Address: (�Ye�-.l Total Depth <br /> Screen Length (from) (to) <br /> Well No.: S "� , S T�2 Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. O&G 732 3 Auger O.D. I.D. <br /> Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company-._L�w <br /> Driller: casing <br /> height <br /> Consultant Z '4 <br /> Geologist 41 V <br /> AEZYE-G Ft CUND <br /> COMPLET{ON CtifaJST'Y-80X <br /> COMPLEMCN <br /> SPECIAL PERMIT INFO. Ground Surf <br /> Distance to sewer line <br /> Grout <br /> Domestic well on site - ( y/ n ) (t. <br /> If yes, location and distance - ft. <br /> ft. <br /> m <br /> SAMPLING — <br /> �loro.•i � <br /> aoc�cn <br /> Holding TemperatureVVI= F <br /> ack <br /> Method _ <br /> Screening Method `c <br /> Tracking Sheet - ( y/ n ) — <br /> fi. = ft. <br /> SPOILS <br /> Storage Method MATERI EVEI.OPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing e :Z <br /> Blank ft Screen ft. <br /> Slot size <br /> GROUPING Bags cement <br /> Buckets bentonit <br /> Depth to water Bags sand/grav <br /> Mix Ratios Filter Pack e/size <br /> Installation Method Surge Block - ( y/ ti ) <br /> Quantity Installed Discussed with geologist: - ( y/ n ) <br /> Type of method_ <br /> EH 29 29 <br />