Laserfiche WebLink
MOMTORING WELL INSTALLATION REPOP'r <br /> Date: CONSTRUCTION <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/christie box (circle one) <br /> Drilling Company: <br /> Driller. cas°.xg <br /> � �� <br /> Consultant <br /> Geologist <br /> ABCVE-GSCUND Cr ;3STY-8CX <br /> Cvtv�!�i;CN CGMPt`TtCN <br /> SPECIAL PERMIT INF©. Ground Suiws <br /> i <br /> Grout <br /> Distance to sever line J <br /> Domestic well on site - ( y/ n Rol <br /> if yes, location and distance - tt. <br /> C <br /> 0 <br /> SAMPLING slat•.ni _ � <br /> saccn — � <br /> Holding Temperature Pack <br /> ,Method <br /> Screenin; Method I— <br /> Tracking Sheet - ( y/ n } <br /> •=- Iff <br /> SPOILS <br /> Storage Method MATERIALS/DBVEI.OPMENT <br /> Contamination Noted - C y/ n ) <br /> Storage Lavation Casing type <br /> Blank ft. Screens ft. <br /> Slat size <br /> GRO€J'l'ING Bags cement <br /> Buckets bentonite <br /> Devrh to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Instailation Method Surge Block: - C y/ n ) <br /> Quantity installed Discussed with geologist: - C y/ n ) <br /> Type of method <br /> cH 29 29 <br />