Laserfiche WebLink
NITORING WELL INSTALLATION REPO <br /> i <br />'l I, <br /> Date: d • CONST'MUCLION44 <br /> } <br /> Premise Address: {-69ti� TotaliDepth,� <br /> Screen Length (from) {to} 2 <br /> Well No.: ,� ' /� V L�� -� _ _ FilterjPack (from) (to) �1J <br /> Bentonite ii (from) 4L (to) _ <br /> Inspector: Grout (from) (to) -�--- <br /> Drilluig rig type <br /> Permit No. a Auger O.D._M 25 I.D. G•2 5r <br /> Completion!- Stove pip ins a bo (circle one) <br /> Drilling Company: <br /> Driller' casing <br /> height <br /> Consultant <br /> Geologist Avap, ! T <br /> ABOVE-GRCUND CHRZTY-BOX <br /> 00*LEr16N COMPLETION <br /> SPECIAL PERMIT INFO Ground Sudan <br /> i grout <br /> Distance to sewer line ,; k <br /> Domestic well on site - / n) ite <br /> If yes, location and di ante . j} fL <br /> SAMPLING slottad <br /> iacrcn <br /> Holding Temperature17 <br /> Method - , <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> ;; ft. } y •= ft. E <br /> SPOILS <br /> Storage Method 1.1 fi. �7d'n <br /> CMATERIALS/DEVELOPMENT <br /> Contamination Noted - W n ) 2II f� <br /> Storage Location Ol.f swv- Casing type,. 4 SC `s PIC- <br /> Blank '2,2, ft. Screen Lo ft. ; <br /> Slot size i <br /> GROUTING Bags'cement <br /> Buckets bentonite <br /> Depth to water Bags'sand/gravel _ w(-.14 <br /> Mix Ratios Filter Pack type/size H f <br /> Installation Method, ___ �_ _ _ � �' } Surge Block: - (y ii ) <br /> Quantity Installed Discussed wi geologist: - (y/ n )� <br /> Type 6fod <br /> EH 29 29 <br /> Vaj. �� 2 <br />