Laserfiche WebLink
G, d PA A, <br /> INSTALLATION REP,..I' <br /> Date:1 I�Q1 CONSTRUCTION <br /> Premise Address:. 32.� 1�1• Total Dep r <br /> Screen Length (from) (to) <br /> Well No.: !3 ,, Z Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: � Grout (from) (to) <br /> C <br /> �2�fvZ� � L Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller:_ �MT��-Cit casing <br /> height <br /> Consultant_/J-AA�� —e <br /> Geologist V <br /> ABOVE-GROUND <br /> CC MPLETO N CNA Z'TY-8OX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line 1'L groat <br /> Domestic well on site - VYce <br /> n ) <br /> If yes, location and dist - h' <br /> ft. <br /> In SAMPLING <br /> Holding Temperatyge — <br /> Method—,oin (� t <br /> Screening Meth <br /> Tracking Sheet y/ n ) <br /> ft. <br /> SPOILS 'M2° <br /> Storage Method MATERIALS VELOPMENT <br /> Contamination Note - ( y n <br /> Storage Location/Vr�/-� Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cern nt <br /> r Buckets entonite <br /> Depth to water �'� Bags s d/gravel <br /> Mix Ratios C _ Filter P ck type/size <br /> Installation Method Surge lock: - ( y/ n ) <br /> Quantity Installedy ,e c�c�h� Disc sed with geologist: - ( y/ n ) <br /> Typ of method <br /> EH 29 29 <br />