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MONITORING wE.LL 1NSTA _An0N REPORT <br /> Date: <br /> CONSTRUCTION <br /> Premise Address: <br /> Tota! Depth - <br /> Well No.: P <br /> Screen Length (from) s <br /> Filter Pack (frog , {ro) � r' <br /> Inspector. )— G--:� (ro) � <br /> { t, Bentonite <br /> (from) <br /> Grour {from <br /> Permit No. Drilling rig type }Auger O.D. <br /> Drilling Company Completion - Stove pipe/cluistie bax <br /> (circle one) <br /> Dr':ller: <br /> Consuatant -~" ca3ing <br /> he-Sht <br /> Geologist - <br /> SPECIA1 pER'vflT <br /> CYC-'rd 5t,-f ~s C`ApL-i7CN <br /> Distance to sewer line <br /> Domestic well an site - <br /> ?` rcct <br /> yes, locationLfi <br /> end di,s.t..�ce <br /> It <br /> b <br /> 1� <br /> 140:d!-ng Ter-nperatu:e G <br /> r`.ethod + cn = <br /> Screeningod �nv� <br /> Tracking"5hcet <br /> StOr2�e SII <br /> Contamination 14'oted - <br /> Srora C Y/(n'j MA TFRIAT SVELOPME,VT <br /> tie Location LL. <br /> Casing type <br /> B lzstk t_- <br /> G-G— U- NNG �fT- Screen 5 + <br /> Slot size . C C ft. <br /> DePLr to waterDass cemenr <br /> t. 1 Buckcts bentonite ter` <br /> MixRoos <br /> l Ba gs sa nd/ ave] . 4 <br /> Instaliat en Method ,.. <br /> Quaniiry Installed Filter Pack type/size <br /> .. ,. <br /> ~_ '.c�c' 'f!I( �� Surge Block: - C Y/(:2 <br /> �9 29 Discussed viith geologisr: - C Y <br /> Type of nethod <br />