Laserfiche WebLink
MONITORING WELL INSTALLATION REPO• <br /> / CON— STR�N <br /> Date: <br /> STotal Depth ([o) <br /> Well No.: <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (Co) <br /> S `�� Q <br /> v Bentonite (from) (C0) <br /> Grout (from) (to) <br /> Inspector. Drilling rig type <br /> Auger O.D. I.D. <br /> Permit No. Completion . Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: he±ght <br /> Consultant <br /> Geologist A-A° '�E-GRD CtiRtST'f-dOX <br /> COWPLEffCN CCt tPL-=T1CN <br /> -- GrcundSufact <br /> SPECIAL PERMIT INFO. drat <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) ft. <br /> If yes, location and distance - — <br /> :ri <br /> _ r <br /> C <br /> — O <br /> S ltor.iM — �p <br /> SAMPLING soden ;- <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n <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 /> GROLRMNG Buckets bentonite <br /> Bags sand/gravcl <br /> Depth to water Filter Pack type/size <br /> Mix Ratios Surge Block: - (y/ n ) <br /> =ktstallation Method Discussed with geologist: - (y/ n) <br /> Quantity Installed Type of method <br /> EH 29 29 <br />