Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: °r� CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: Screen Length (from) (to) <br /> 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 /> height <br /> Consultant T <br /> Geologist 37 r <br /> ABOVE-GROUND <br /> COMPLETION CHAIM-BOX <br /> SPECIAL PERMIT INFO. Groundgurfaci COMPLETION <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) 1 tt <br /> If yes, location and distance - .L— <br /> tt. <br /> tt. <br /> A <br /> O <br /> SAMPLING = <br /> dotted _ � <br /> sac5on <br /> Holding Temperature = � <br /> Method = Pack <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 <br /> Blank ft. Screen fr. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 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 />