Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> CONSTRUCTION <br /> Date: <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from)—(Co) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: � height <br /> 'y <br /> Consultant T <br /> Geologist A80VEGF1CUND Ct-SZ Y-Box <br /> COMPLETCNGmuCgWpV�T1CN <br /> SPECIAL PERMIT INFO. �$� <br /> grm,t <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - tt <br /> tt. <br /> — m <br /> _ = o <br /> tlorod � <br /> SAMPLING toc.cn = <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 ) Casing type <br /> Storage Location Blank ft Screen —K <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Filter Pack type/size <br /> Mix Rados <br /> Surge Block: - ( y/ n <br /> Installation Method ) <br /> Quantity installed Discussed with geologist: - (y/ n) <br /> Type of method <br /> EH 29 29 <br />