Laserfiche WebLink
G <br /> ONITORING WELL INSTALLATION REP0 <br /> CONSTRUCTION <br /> Date: <br /> Total Depth <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) <br /> Well No.: . Bentonite (from) <br /> Grout (from) (to) <br /> Inspector- Drilling rig type 1.D. <br /> Auger O.D. <br /> Permit.No. Completion- Stove pipe/dluistie box (circle one) <br /> Drilling Company: <br /> casing <br /> Driller: T height <br /> Consultant <br /> Geologist ABOVE-GRCVN0 CHRMW-god( <br /> 00kPLEiION CCMPlZnCN <br /> C3['OC1C�Sui•Iaet <br /> SPECIAL PERMIT INFO. <br /> '� grout <br /> Distance to sewer line <br /> Domestic well on site - (y/ n} t <br /> If yes, location and distance - n'L <br /> Av <br /> �n M <br /> �^,4r <br /> 4 <br /> tloiad •,` C <br /> SAMPLING soc9cn <br /> .N <br /> Holding Temperature : = gn'�! <br /> ack <br /> Method ` <br /> Screening Method <br /> Tracking Sheet - (y/ n 3 <br /> .., <br /> 4T !N <br /> IF <br /> SPOILS <br /> Storage Method MATERIALS EVEL.OPMENT <br /> Contamination Noted - (y/ n) Casing type <br /> Storage Location Blank �, Screen_ • <br /> Slot size <br /> GROUTING <br /> Bags cement <br /> Buckets bentonite <br /> Sags sand/gravel <br /> Depth to water <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - (y/ n } <br /> D - (y/ n ) <br /> Discussed with geologist: <br /> Quantity Installed Type of method <br /> EH 29 29 <br /> s <br />