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MONITORING WEU IN TIO ORT <br /> Date; <br /> CQ—NSTRUC77ON <br /> Premise Address: Total Depth � � <br /> Well l Now: Screen Care (from (to) <br /> Filter Pack (from) <br /> t <br /> Inspector. Bentonlre (Ener..) 1 (to) <br /> Grout (r0rn —-. (t <br /> Permit No. Drilling rig type <br /> Auger O.D. I.D. <br /> Drilling mp Completion-Stave pipe/cl ' tie ; (circle one), <br /> Driller: <br /> casing <br /> Consultantheight <br /> gh <br /> Cteldis ' <br /> ASZVE <br /> -GD <br /> SPECIAL PER-MIT INFo. <br /> SLTfacv <br /> Distance to sewer line <br /> Darn stic well on site r <br /> If Yes; location i hrnce <br /> S t Ts�IG <br /> le <br /> Holding Tern erature cry <br /> Method <br /> Screening Method <br /> "racking Sheer - n <br /> SII <br /> Storage Method �A T IDP <br /> Contazinationpated ra <br /> Storage Location <br /> Casing type <br /> Blank Screen r t <br /> P. Slat size <br /> Bags c ment <br /> Depth to eater... Buckets bentonite <br /> -mi Fa ias Bags rid vel <br /> Installation Method ' filter lack t e/si <br /> Quantity Installed r Surge Block. - <br /> Discussed with gdologisr, .' <br /> EIS 29 29 Type of method <br />