Laserfiche WebLink
MONITORING WELL IN TION <br /> � ONITORiN'WELL INSTALLATION REP' -: <br /> CONS N <br /> Date: Total Depth (to) — <br /> Screen Length (from)---(to) -- <br /> Premise Address: Filter Pack (from)---- <br /> Bentonite <br /> from)_Bentonite (from)-- —"—'(to) <br /> well No.: Grout (from) <br /> Inspector. Drilling ng type I.D. <br /> Auger O.D. <br /> Permit No. <br /> Completion - Stove pipe/dtrtstie box (circle one) <br /> Drilling Company �^ casing <br /> II II height <br /> Driller: ` <br /> Consultant <br /> ABOVE-GROUND CNRISTY-3OX <br /> Geologist COMPLEMN COMPL=-MON <br /> ..�Ground Sislaas <br /> SPECIAL PERMIT INFO. grout <br /> Distance to sewer line <br /> Domestic well on site - (Y/ n) tt. <br /> If yes,location and distance <br /> C <br /> O <br /> slorA C <br /> SAMPLING socicn <br /> _ _ Lrsvd rxtc <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) _tt. <br /> SPOILS MATERIALS/DE OPMENT <br /> Storage Method Casing type <br /> Contamination Noted - (Y/ n) Blanker--ft Screen—�fi <br /> Storage Location 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/ tt ) <br /> installation Method Discussed vrith geologist: - (y/ n) <br /> Quantity Installed Type of ncthod <br /> EH 29 29 <br />