Laserfiche WebLink
MONITORING WELL INSTALLATION REPOT <br /> Date: _ 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/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> rf] heightght <br /> Consultant _ <br /> Geologist <br /> ABOVE-GROUND CSW tSTY-30X <br /> CO NVL`T C N COMPLEMCN <br /> SPECIAL PERMIT INFO. G=rd sLeacs -_ + <br /> Distance to sewer line ZR <br /> Domestic well on site - ( y/ n ) �_.ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> C <br /> O <br /> SAMPLING Alor." _ .E <br /> sacncn = <br /> Holding Temperature = x V91 Pack <br /> Method — <br /> Screenino Method —_ <br /> Tracking Sheet - ( y/ n 7i, <br /> J• _ <br /> ft. ir <br /> SPOILS <br /> Storage Method_ MATERIALS/DEVELOPMENT <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 Bags sand/gravel <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 metliod <br /> EH 29 29 <br />