Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> Z/a�r�� CONSTRUCTION �40 PAfP <br /> Premise Address: at `// n � Total Depth <br /> //? A4_ Screen Length (from) (to) <br /> Wel] No.t � 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 /> Drilling Company: Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> C <br /> '/ nA&/ height <br /> Consultant //(,c <br /> Geologist _ 7ET <br /> ABOVE-GROUND <br /> COMPLETION CHAISTY48OX <br /> SPECIAL PERMIT INFO. pend Surface COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - n• <br /> - ft ft. <br /> a <br /> — m <br /> SAMPLING = <br /> •lotted = <br /> aacton — <br /> Holding Temperature = <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) _ <br /> ft. <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing e <br /> Blank ft. Screen ft. <br /> Slot siz <br /> GROUTING Bags c ent <br /> Bucke bentonite <br /> Depth to water �� -� Bags d/gravel <br /> Mix Ratios Filter ack type/size <br /> Installation Method_ &__.�h�j 1 Surg Block: - (y/ n ) <br /> Quantity Installed Disc ssed with geologist: - ( y/ n ) <br /> Typ of method <br /> EH 29 29 <br />