Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: <br /> ---- CONSTRUCTION <br /> Premise Address: Total Depth <br /> Well No.: <br /> Screen Length (from) (to)_Filter Pack (from) <br /> (talt <br /> '— <br /> Bentonite (from) ( <br /> Inspector: to)__Grout (from) (to)- <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Drilling Company: <br /> Completion -,Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> Consultant <br /> --- height <br /> Geologist <br /> AZC VE-GROUND <br /> CCWLETION C4-RIS7 -BOX <br /> SPECIAL PERMIT INFO COMPLET ON <br /> Grmnd Surfxa <br /> Distance to sewer line Grout <br /> Domestic well on site - (y/ n ) <br /> If yes, location and distance - ;ft <br /> — o <br /> _ 4 <br /> —4 F-1 I <br /> SAMPLING — <br /> t c <br /> Holding Temperature sic-ron <br /> Method -- - ga„eg P <br /> ack <br /> Screening Method -- — <br /> .f — <br /> Tracking Sheet - (Y/ rl ) -- <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) -- <br /> Storage Location _ Casing type <br /> Blank ft. Screen fr, <br /> GROUTING Slot size <br /> Bags cement <br /> Depth to water Buckets bentonite <br /> 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 /> EH 29 29 Type of method <br />