Laserfiche WebLink
�.ONITORING WELL INSTALLATION MPC,-,/ <br /> - - 6w,/P <br /> -�v <br /> Date: d�I�GSr CONSTRUCTION <br /> S <br /> Premise Address: � Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/cluistie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height: <br /> Consultant6LIV —WW—f <br /> Geologist -- <br /> AEZVE-GRCUND GiFifM-BOX <br /> GOIFLEf ION MOPLEMN <br /> PECIAL PERMIT INFO. Ground Sutaca <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n) �_.ft. <br /> If yes, location and distance - ft. <br /> lt. <br /> � C <br /> SAMPLING slorai <br /> toecn <br /> Holding Temperature <br /> Method _ � Pack <br /> �.: <br /> Screening Method <br /> Tracking Sheet - (y/n <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination voted - [y/n ) /it / <br /> Storage Location Casing type `t Ell <br /> Blank ft. Screen ft. <br /> SIot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water _ Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Me0od Surge Block: - (y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />