Laserfiche WebLink
MONITORING WELL INSTALLATION REPORT <br /> Date: I 1 �p a 5 CONSTRUCTION <br /> Premise Address: ( � I SQcna �5 �v` • Total Depth / <br /> ,tt�� Screen Length (hom) (to)Cr <br /> Well No.: l/ 5 dS� JJa w �,� Q `Filter Pack (from) (to) <br /> Bentonite (from) 5 ' (Co) <br /> Inspector. Grout (ho ) (to)T <br /> Drilling rig type I l 6 l tk) 5 C.Y � <br /> Permit No._ 3�5 jp 3� S ] Auger O.D._ 1 p" I.D. <br /> D.— <br /> Drilling Company. e�1� 'I �— Completion - Stove pipe/duistie box (cirde one) <br /> Drillin Com an . f� I <br /> JJ <br /> Driller: casing <br /> I r2& �' height <br /> .Consultant 1 1�. h1 l ey�L�. '4 ,�. <br /> Geologist ► r w�lJc—�/I PitID�L <br /> ABOVE-GRCUND <br /> COWLErION CtffiStY 30X <br /> COtAPUTION <br /> SPECIAL PERMIT INFO. O��Sutacr <br /> Distance to server line Oat <br /> Domestic well onsite - (y/ n) _ft <br /> If yes, location and distance - <br /> 25 ft. ft. <br /> = o <br /> — c <br /> SAMPLING <br /> ilonod — <br /> socicn <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n) tf q D '! C <br /> Storage Location Casing type 7 7 V <br /> Blank fr. Screen ft. <br /> Slot size _ <br /> GROUTING Bags cement <br /> Buckets bentonire <br /> Depth to water Bags sand/gravcl <br /> Mut Ratios Filter Pack type/size <br /> 3pstallation Method Surge Block: - (y/n ) <br /> Quantity installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29. . <br />