Laserfiche WebLink
�MONITORING WELL INSTALLATION REPOnt <br /> Date:inz?b CONSTRUCTION <br /> Premise Address:_ c:n:Pl r a Total Depth_ �S <br /> ����� Screen Length (from) ?fes 3 <br /> Well No.: r.I�li(i(/'d noT (to) S/ Filter Pack (from) Z (to) 35 <br /> Bentonite (from) 21 (to) Z� <br /> Inspector: Grout (from) 2-( (to) o <br /> -00 �-7 �6 Drilling rig type -75 <br /> Permit No. <br /> Auger O.D. $( I.D. <br /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: -�/' '�) • Y <br /> j♦' casing <br /> Consultant <br /> 45b& height <br /> Geologist •_ <br /> (/ V ABOVE-GFCUND <br /> COMPLETION tgo <br /> SPECIAL PERMIT INFO. Grourd guff <br /> COMPLETION <br /> Distance to sewer line LSO Grout <br /> Domestic well on site - (yn <br /> If yes, location and distance® �� tt• <br /> — m <br /> = o <br /> SAMPLING <br /> — o <br /> .Ionod = $ <br /> aocdon <br /> Holding Temper ture U <br /> Method ?W gmyW Pa.* <br /> Screening Method !�!t <br /> Tracking Sheet - y n ) tt. IF <br /> tt <br /> SPOILS <br /> Storage Method el MATERIALS/DEVELOPMENT <br /> Contamination Note - 0 n ) � ` <br /> Storage Location L - (tJ l Casing type l' ®✓ c <br /> Blank ?1> ft. Screen to h. <br /> Slot size 'd /o <br /> GROUTING Bags cement <br /> p Buckets bentonite <br /> Depth to water C1 Bags sand/gravel <br /> Mix Ratios Filter Pack type/size .27/-z- <br /> Installation <br /> /2Installation MethodSurge Block: - (y nn <br /> Quantity Installed Discussed with geologist: - (y/n} <br /> EH 29 29 Type of method <br />