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- H MONFTORING W�.LL.INSVJJ-ATFON 11RT. <br /> q CONSTRUC-TION. <br /> Date: Total Dept <br /> Premise Address: <br /> Screen Length (from) (to)____�— <br /> " 1 4 <br /> ter Pack. (from) (to)-------------7 <br /> Well No.• `'- "fir .^Bentonite (from) (to) <br /> 7 w-Grour (from} <br /> Inspector'. r -Drilling rig tYPe :, �• _ ti <br /> 4 LD. <br /> p Auger O.D. c Christie box (circle one) <br /> permit No. Completion - Stove pip / <br /> r <br /> Drilling Company casing' M1 <br /> Driller: —�F height" <br /> Consultant <br /> Geologist p�}�L,-�'CiO N C,ot.lr^t^i3c N <br /> SPECIAL PERMIT INFO. Brat <br /> Distance to sewer line „ <br /> Domestic will on site - (Y/ n} •r <br /> If yes, location and distance <br /> S LNP^lam <br /> Holding Temperature r_ <br /> Method <br /> Screening Method ` ' <br /> Shcet - (Y <br /> Tracking � n � <br /> SPOILS <br /> MATERIALS 1 OPMENI <br /> Storage Method <br /> Contarninadon Noted - (Y/ n J Casing type Screen f <br /> Storage Location ' Blank fr . <br /> Slot size <br /> Bags cement <br /> GRA NG Euckets bentonite <br /> Bags sand,/g-ravcl , <br /> Depth to water' �- � ,,Frltcr.Pack type/size <br /> Mix Ratios Surge Block: - (Y/n J <br /> Discussed with geologist: - (Y <br /> pstalladon Method � 4 Type of rnc[liod <br /> Quantity Installed - <br /> EH 29 29 <br /> �; <br />