Laserfiche WebLink
tONITOAING WELL INSTALLATION REP <br /> Date: CONSTRUCTION <br /> Total Depth t�� <br /> Premise Address: (to) <br /> �t Screen Length (from) <br /> WellNo.: 1 Filter Pack (from) (to) <br /> p , � j� } Bentonite (from) (to) <br /> Ins ector �UJU1t"7C Y WY`AWr"� 6�� Grout (fro m)�_(to) <br /> P V Drilling rig typo �[ <br /> Permit No. <br /> S rL21 C)9-q Auger O.D.___ I.D. <br /> y Completion - Stove pipe/cluutie box (circle one <br /> Drilling Company: �J„1P Ck �2�.✓t <br /> � casing \ <br /> Driller: �����rr rte/ height <br /> Consultant <br /> Geologist n1 - AgpyE.GpCUND c4wiSiy.3pX <br /> COIr4�LR10N comm_-mN <br /> SPECIAL PERMIT INFO. G=rd sort <br /> prat <br /> Distance to sewer line <br /> Domestic well on site - ( y/ n) ft. <br /> If yes, location and distance - tt- <br /> ft. — <br /> nq. <br /> Y' <br /> C <br /> SAMPLING 11onadsacicn <br /> Holding Temperature r = p.vd rac c <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) T' — <br /> tt. — <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blank {Y Screen ft• <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravcl <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />