Laserfiche WebLink
WINITORING WELL INSTALLATION REP 'r <br /> / // CONSTRUCTION <br /> Date: // <br /> S 1 Yrs' Total Depth <br /> Premise Address: Screen Length (from) (to) <br /> C ('1 Filter Pack (from) (to; <br /> Well No.: Bentonite (from) <br /> Grout (from) (to) <br /> Inspector: Drilling rig type <br /> Permit No. <br /> Auger O.D. I.D. <br /> ` i �jw Completion - Stove pipe/christie box (circle one <br /> Drilling Company: Itll-11 <br /> casing <br /> Driller: height <br /> Consultant —WV–f <br /> Geologist AgoyE-GROUND <br /> COMPLETION COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. tend Sudao: <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/n) <br /> If yes, location and distance - ft. <br /> SAMPLING slotted <br /> sadon <br /> Holding Temperature lave,pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/fn) _ <br /> /,ef1/.e& 5�/ ^ C// a <br /> SPOILS � <br /> �vc�� Y"� <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 method <br /> EH 29 29 <br />