Laserfiche WebLink
4 <br /> MONITORING WELL.INSTALLATION REPORT <br /> CON STft JC-MON <br /> Date: l <br /> 4',, t,,._ ._ Total Depth <br /> Premise Address: : - Screen Length (from) (to) <br /> Well No.: <br /> Filter Pack (from) (to) <br /> , '` — <br /> Bentonite (from) (t°) <br /> Grout (from) (to) <br /> Inspector i.r` Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion - Stove pipe/clu•istie box (circle one) <br /> Drilling Company <br /> casing <br /> Driller• ' —:F he-ght <br /> Consultant <br /> Geologist A—RC E-GRCtJN0 ChRZ7Y-B4OX <br /> CO W LEMO N Cphir t,'TICN <br /> -- C-cc;rd SLzfsci <br /> SPECIAL PiRMIT INFO. <br /> 9r�Z <br /> Distance to sewer line -[t. <br /> Domestic well on site - (y/ n) fr- <br /> lf yes, location and distance - <br /> >" r <br /> 6 <br /> SAMPL.ING <br /> Holding Temperatuxe' <br /> Method <br /> Screening Method <br /> Tracking Sheet - {y/ n) tt. <br /> -- ft. <br /> SPOILS <br /> MATERIALS/DEVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n} Casing type <br /> Storage Location Blank—.ft- Screen ' <br /> Slot size <br /> Bags cement <br /> GROUUNG Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Park type/size <br /> Mix Ratios Surge Block: - ( y/ n ) <br /> installation Method Discussed with geologist: - (y/ n ) <br /> Quantity installed Type of method <br /> EH 29 29 <br />