Laserfiche WebLink
r,o,--4ITORING WELL INSTALLATION REPOR, <br /> Date: J CONSTRUCTION <br /> Premise Address: L N IhA J N�A�u�iTotal Depth <br /> Screen Length (from) (to) <br /> Well No.: 4 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 /> height <br /> Consultant 11 T77 <br /> . . —WGeologisT <br /> ABOY>;•GACLJND CtfRZ Y-BOX <br /> COMPLETION COMPLETION <br /> SPECIAL PERMIT INFO. Wfacs <br /> Distance to se,.ver line <br /> Qrout <br /> Domestic well on site - (y/ n) }. it. <br /> If yes, location and distance - ft• <br /> A <br /> SAMPLING dorn.i _ <br /> sacdcn <br /> Holding Temperature �v� <br /> Method _ <br /> Pack <br /> Screening Method ' <br /> Tracking Sheet - ( y/ n) _ <br /> SPOILS <br /> Storage Method }� MATERIALS EVEI.OPMENT <br /> Contamination Noted - C ytl n ) <br /> Storage Location &Z::Z Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 0-6 -1 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 />