Laserfiche WebLink
MONITORlNG WELL INSTALLATION RET <br /> s <br /> Date: C' ` -_• CONSTRUCTION <br /> I <br /> Premise Address: -15-" i.`w Tota! Depth � <br /> Screen Length (from) '3 S (to)-3 . <br /> Well No.: Filter Pack (from) 35 (to)-245 <br /> Bentonite (from) 2 —(to)----,( <br /> Inspector. _\rU Grout (from) 'z-tr, (to) S ire <br /> Drill in g rig type <br /> Permit No. �� Auger O.D. I.D. <br /> Drilling Company: l <br /> Completion - Stove pipe/clirisde box (circle one) <br /> `t <br />{ Driller <br /> • casing <br /> �► height <br /> Consultant (�-- <br /> Geologist <br /> ABCVE-GAMND <br /> CCl,�l.rR1Q N <br /> SPECIAL PERMIT INFO CO&PLETCN <br /> Cxxn4 S�xixs <br /> Distance to sewer line Qraut <br /> Domestic well on site - ( y/ n ) <br /> If yes, location and distance <br /> fZ.�b ft. ' <br /> r <br /> a <br /> SAMPLING - — <br /> flow c <br /> Holding Temperature :acicn <br /> Method <br /> gnV9+Pack <br /> Screening Method <br /> Tracking Shcet - (y/ n ) . <br /> SP01LS ft. <br /> Storage Method G-Q.*AL_- . _ <br /> Contamination Noted - (y/n j MATEPJALS EVEI OPMENT <br /> Storage LocationJZMi:iP= _ �1I . VC <br /> -- Casing type <br /> } <br /> Blank__,� --fr• Screen <br /> GR�Iti;G Slot size <br /> Bags cement <br /> Depth to Nater. �-� Buckets bentonite <br /> Mix Ratios Bags sand/gravel <br /> Installation Method Filter Pack type/size <br /> Quantity Installed Surge Block: - (y/ 11 ) <br /> Discussed with geologist: - (y/® <br /> EH 29 29 - Type of metliod <br />