Laserfiche WebLink
\./NITORING WELL INSTALLATION REPO <br /> Date:,, ( 'L3&.3 - _ CONSTRUCnON <br /> Premise Address:_ ��7 • [�P'L� tS Total Depth <br /> Screen Length (from)_,,, (to) <br /> Well No.: � Filter Pack (from) (to) -TR <br /> Bentonite (from) (to) <br /> Inspector: Grout (from (to) <br /> e3 ' Drilling rig tYPe <br /> Permit No. 7 Auger O.D. I.D. I 4E <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling company: <br /> Driller: asing <br /> �- Tt <br /> height <br /> Consultant <br /> Geologist, _ �^ T <br /> —O <br /> CHFUM41OX <br /> ABovE-GRCxltvp . <br /> COMPLETION COMPaT oN <br /> SPEQAL PERMIT INFO. ` / Ciroynd Suriaca <br /> Distance to sewer line �/�' P°A <br /> Domestic well on site- It <br /> If yes, Iocadon and dis ye.nG <br /> ) ? <br /> fL <br /> •lat•. d .zr <br /> spa 4�irlCl1 <br /> Holding Tem 47w <br /> Method � Pack <br /> Screening Method_-_ <br /> Tracking Sheet -[YY n) : - <br /> S29ILS U5, <br /> A <br /> Storage MethodA ) b=EUM=EVELOPMENT <br /> Contamination Noted - <br /> Storage Location Casing -- <br /> Blank fL Screen10 ft. <br /> Slot size • a! <br /> t N Bags cement <br /> / Buckets bentonite <br /> Depth to water f1 Bags sand/gravel <br /> Mix Ratios Filter Pack typesize <br /> Installation Method Surge Block: - (y/n) <br /> Quantity"Installed <br /> Discussed with geologist: - {y/n) <br /> Type of method <br /> EH 29 29 <br />