Laserfiche WebLink
} <br /> MONITORING WELL INSTALLATION REPORT <br /> C. l <br /> i <br /> Date: �� 1 1 CONSTRUCTION <br /> Premise Address: � Well No. 1� W <br /> Inspector: Total Depth <br /> Screen Length ,5 <br /> Filter Pack j 7 <br /> Bentonite Pellets -'2- <br /> Permit No. l 6 Grout l� :S <br /> Consultant Q---U-4s � Completion -'Stove. pipe/christie box <br /> ., Geologist f <br /> Auger! O.D. , <br /> Auger .�I.D.�� <br /> SAMPLING " 1 <br /> ttidt.up <br /> E Holding Temperature <br /> Method <br /> Screening Method ,_ M <br /> ABOVE-GROUND GEIRISTY-SQX <br /> i Tracking Sheet (y/n) COMPLETION COMPLETION <br /> Ground Surface <br /> SPOILS <br /> i grout <br /> r <br /> Storage Method �� (P <br /> 4C Contamination Noted - yes/no 1,/ tt' <br /> Storage Location $ ft' <br /> SPECIAL PERMIT INFO. j} _ f <br /> ''v. — c I <br /> Distance to sewer line sacctlan A __ 11 <br /> Domestic well on site - yes/nopack <br /> If yes, location & distance - a "'` _ vW <br /> lie <br /> GROUTING <br /> MATE,RIALS'!VSED: <br /> Depth to water rs Casing type t/C <br /> f <br /> Mix Ratios Blank ( b ft. Screen /-5 ft. <br /> Installation Method Slotllsize:j <br /> Quantity Installed Eagsjj�cemept <br /> Buckets bentonite <br /> Bagsi sand/,gravel <br /> Filter Pak type/size 3 <br /> ! Total Billed Time Per Site { <br /> Bate Permit Finalized <br />