Laserfiche WebLink
F <br /> _.JNITORlNG WELL.INSTALLATION REPO+.;., J <br /> Date: .� �x' CONSTRUCTION / - <br /> ,(1�,�,6�jt� L� Total Depth �O`� <br /> Premise Address:_ - n Screen Length (from) Z (to) <br /> Well No.: - E'�W '2 Filter Pack (from) <br /> (to) ..t� <br /> Bentonite_' (from) Eto) Z <br /> Inspector: s Grout (from) — ! Z {to)` -t <br /> Drilling rig type <br /> Permit No. • ' Z Auger O.D. S LD. <br /> Completion-Stove pipe/cluistie box (circle one) <br /> 'Drilling Company: <br /> casing u <br /> Driller: dill height:' l- - <br /> Consultant r <br /> GeologistJ1gOVE4RG'tJND <br /> COWLET$0N CHRL'IN OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO - .-t f 'Ground Sacs <br /> grout 'A ` <br /> Distance to sewer line } '°� <br /> Domestic well on site ,y/ n <br /> - { tt- <br /> if yes, location and distance - - n. <br /> _ - «,fir ice' � .�,.. w'• � <br /> SAMPLING <br /> &*don <br /> Holding Temperatures graL pack i <br /> wi <br /> Method C cV41' <br /> Screening Method QL141 ' j�' - <br /> Tracking Sheet _O n) <br /> a <br /> SPOILS ; <br /> t <br /> r` <br /> Storage Method Ali,. MATERIALSZQEWLOPMENT <br /> Contamination Noted - {y/ n) " y� <br /> Storage Location- Casing type 4L ` <br /> Blank ft. Screen ft. <br /> # Slot size 0 0 2A-) . <br /> GROLMN_ G Bags cement <br /> � ® Buckets bentonite 3 <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/s <br /> a <br /> Installation Method Surge Block: = ( n ) <br /> w <br /> Discussed with_geologist: - <br /> Quantity Installed -, g <br /> Type of method t <br /> I~H 29 29 _ µ <br /> 4 ! l 7 <br />