Laserfiche WebLink
*N1TORING WELL INSTALLATION REPCO <br /> CONST ON <br /> Date: � � "/SSS � <br /> Total Depth <br /> Premise Address:Address: Screen Length (from3-- -Bent <br /> to) <br /> cn Pack ( (to) <br /> Grout (from) <br /> Well No.: C Bentonite (from) (to) — <br /> �— <br /> Inspector. Drilling ng type I.D. _---- <br /> Auger O.D.______� <br /> Permit No, Completion - Stove pipe/christie box (circle one) <br /> Drilling Company <br /> ^� casing <br /> Driller: I I height -i- <br /> Consultant r <br /> AS0VE.GRCIJND CMRISTY-BOX <br /> Geologist C0kgLc'r*N COMPt–noN <br /> Ground Surface <br /> SPECIAL PERMIT INFO• orout <br /> Distance to sewer lineft. <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance • ft• _ <br /> a <br /> tlorai � � <br /> SAMPLING aocicn <br /> tnr~ <br /> �+1 <br /> N <br /> Pack <br /> Holding Temperature = YY <br /> Method "r? <br /> Screening Method_------------, <br /> Tracking Sheet - Cy/ n) = _ <br /> SPOILS <br /> MATERIALS/DEV EI,OPMENT <br /> Storage Method <br /> Contamination Noted • (y/ t1) Casing type ft- <br /> Storage Location Blank�ft. Screen — <br /> Slot size <br /> Bags cement <br /> GROLMNG Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios _ Surge Block: - (y/ 11 ) <br /> Installation Method Discussed with geologist: • ( y/ n ) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />