Laserfiche WebLink
—MONITORING WELL INSTALLATION REPQi T <br /> Date: I 'f 3 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No, Auger O.D. I.D. <br /> Completion - Stove pipe/cluristie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> IF17 t height <br /> Consultant <br /> Geologist <br /> ABCVE-GROUND C4 ARZTY-30X <br /> COMPL=TICN COMP=ON <br /> SPECIAL PERMIT INFO. G=rid Surfaca <br /> Distance to sewer line grout <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance - �- <br /> SAMPLING tlor.ad C <br /> i9C'1Cn <br /> Holding Temperature <br /> Method <br /> ficreenin0 Method . <br /> Tracking Sheet - ( y/ n ) <br /> Ito <br /> SPOILS <br /> Storage Method MATERIALS42EVFLOPMENT <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 - 1 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method _ -__- Surge Block: - ( y/ zi } <br /> Quantity installed Discussed with geologist: - ( y/ n } <br /> Type of method <br /> EH 29 29 <br />