Laserfiche WebLink
•MONITORING WELL INSTALLATION REPC)RT <br /> Date: S/�/� CONSTRUCTION <br /> Premise Address: It, �7 00 Aj t.�M Total Depth <br /> t Screen Length (ftom) (to) <br /> Well No.: ` e"y ' Filter Pack (from)—(to)- <br /> Bentonite <br /> from) (to)Bentonite (from) (to) <br /> Inspector. d9 6 "^�� Grout (from)—(to)- <br /> Drilling <br /> from) (to)Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: T casing <br /> T height <br /> Consultant � T <br /> T <br /> Geologist ABOVE-GROUND <br /> CONFLE'fION CCOOMPLETIONMPLEMN <br /> SPECIAL PERMIT INFO. Ground Sudan <br /> Distance to sewer line oras <br /> Domestic well on site - (y/ n ) �_ft. <br /> If yes, location and distance - g- <br /> tt. <br /> ;y <br /> w <br /> O <br /> SAMPLING slot." <br /> sacicn — <br /> Holding Temperature = g" *I pads <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type G <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water lyb-g� Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />