Laserfiche WebLink
Date: <br />Premise Address: <br />Well No.: <br />Inspector. <br />Permit No. <br />Drilling Company: <br />Driller: <br />Consultant <br />Geologist <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n) <br />If yes, location and distance - <br />Grcurs:1 SL.si act <br />Pf 504, <br />305t tu-4,-(ri) MONITORING WELL INSTALLATION REPORT <br />CONSTRUCTION <br />Total Depth <br />Screen Length (from) (to) <br />Filter Pack (from) (co) <br />Bentonite (from) (co) <br />Grout (from) (to) <br />.Drilling rig type <br />Auger O.D. ID. <br />Completion - Stove pipe/christie box (circle one) <br />SAMPLING <br />Holding Temperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />casing <br />height <br />A.BOVE-GRCUND CKT,STY-ECX • <br />COMPLETfON <br />COMPU--71CN <br />SPOILS <br /> <br />MATERIALS EVELOPMENT <br />Casing type <br />Blank ft. Screen <br />Slot size <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Surge Block: - ( y / n) <br />Discussed with geologist: - ( y / n) <br />Type of method <br />Storage Method <br />Contamination Noted - ( y / n) <br />Storage Location <br /> <br />GROUTING <br /> <br />Depth to water <br />Mix Rados <br />4nstallation Method <br />Quantity Installed <br /> <br />EH 29 29 <br />