Laserfiche WebLink
.'MONITORING WELL INSTALLATION REP(-.-- <br /> Date: <br /> EP(.._-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 /> height <br /> Consultant TV <br /> Geologist •- T <br /> A3CVE-cac4JND CHMST r-Box <br /> COMPL`F r;0N COMPLETICN <br /> SPECIAL PERMIT INFO. Ground Suiaos <br /> Distance to sewer line Qrcvt <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ft. <br /> ft. ft. <br /> C <br /> O <br /> SAMPLING slo6d <br /> aocicn _— � <br /> Holding Temperature = Ravi F <br /> ack <br /> Method =_ <br /> Screenin;Method <br /> Tracking Sheet - ( y/ n ) r" <br /> �.�.ft. ft. <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 method <br /> EH 29 29 <br />