Laserfiche WebLink
MONITORING WELL INSTALIATION REPORT <br /> Date: I 6 Z CONSTRUCRON <br /> (} Lp � �; Total Depth <br /> Premise Address: Screen Length (from) (to) <br /> Well No.: 0 �+ Filter Pack . (from) (to) <br /> Bentonite (from) (to) <br /> Grout (from) (to) <br /> Inspector. � Drilling rig type <br /> Auger O.D. LD. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: F height <br /> us � <br /> Consultantn n �---' T <br /> GeologisttiLI`1 AI. CVE-GRGUND C�iR TY_Box ' <br /> COIPLETIoN cc+MPL—=ncN <br /> Ground sursx. <br /> SPECIAL PERMIT INPO- <br /> grccrt <br /> Distance to sewer line ��tt- <br /> Domestic well on site - (y/ n) . <br /> If yes, location and distance - <br /> VM <br /> J+ <br /> 1• � <br /> O � <br /> SAMPLING socicn <br /> Holding Temperature . F <br /> Method <br /> Screening Method ` _ <br /> Tracking Sheet - (y/ n) <br /> SPOILS <br /> MATERIALS EVELOPMENT <br /> Storage Method <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location gl ft. Screen <br /> Slot size <br /> Bags cement <br /> GROUTING Buckets bentonite <br /> Bags sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (Y/ ;1) <br /> Installation Method Discussed with geologist: - {y/ n) <br /> Quantity Installed Type of rncthod <br /> EH 29 29 <br />