Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> CONSIRLICTION <br /> Date: <br /> cjt/ Total Depth <br /> Premise Adc�resst Screen Length (from), (CO) <br /> Filter Pack (from) (to) <br /> Well No.: Bentonite (from) (to} <br /> .^r� - 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: height <br /> Consultant <br /> Geologist _ ASGVF_-GRCUNO 3OX <br /> COVPL TfON <br /> Cxxt;x�5�rtxt ""'� <br /> SPECIAL PERMIT INFO. <br /> 9t�t <br /> Distance to sewer line _ ft. <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - <br /> o <br /> C <br /> O <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> MATERIALS EVEI.OPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n } Casing type <br /> Storage Location Blank Et. Screen fr' <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/ n ) <br /> installation Method Discussed vAEh geologist: - (y I n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />