Laserfiche WebLink
i <br /> ' MONITORING WELL INSTALLATION REPORT <br /> I <br /> i <br /> Date:/ /3 Ol _ CONSTRUCTION ; <br /> Premise Address:_ �� r��� __ �� Total Depth <br /> g Screen Length (from) (to) <br /> ��// <br /> Well No.: V r-C V e , ek'l, �K`3— Filter Pack (from) (to) <br /> r Bentonite (from) (to) <br /> Inspector: ?Ff� _ Grout (from) (to) <br /> Drilling rig type i <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company; <br /> Driller: casing <br /> /� � height <br /> Consultant �' O <br /> Gest <br /> ABOVE-GROUND C,tiRtSTY-BOX i <br /> COf.3PLETiON COMPLETION <br /> SPECIAL PERMIT INFO. Ground SurEacs �.:. . <br /> Distance to sewer line grow <br /> Domestic well on site - (y/n) tt- <br /> If yes, location and distance - . <br /> lY. <br /> 4 " � <br /> SAMPLING <br /> &Iotiad Y� c i <br /> &*clan <br /> Holding Temperature <br /> Method _ 9MVW pack. <br /> Screening Method <br /> Tracking Sheet - {y/n } x q <br /> SPOILS <br /> i <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ] i <br /> Storage Location Casing type <br /> BIank ft. Screen ft: <br /> Slot size <br /> GROUTING �' ( ` ` Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> ...> <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 />