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.5 <br /> M. <br /> ' MOFt1NG WELL REPORT <br /> Date: -A-q 2 CONSTRUMON <br /> Premise Address: 5� o . ri-t, Total Depth -eW <br /> Screen (from) (to)— <br /> Well No.• _ n4w - -- Filter Pack ) (to).,_.-��_ <br /> Bentonite (from (to) <br /> Inspector._ 4� J Grout (from) (to) <br /> Dulling rig type <br /> Permit NO.-21-2214 --- Auger Q.D. I.D. <br /> Completion-Stove pipe/christie box (circle o <br /> Drilling Company:_ . <br /> Driller. � lseigh4 <br /> Consultant -•� <br /> Geologist ABov>ra T <br /> l 0 CO <br /> J40 . <br /> comminoN <br /> SPECIAL PERMt7 tNPQ- Grour+d$acme <br /> Distance to newer line W=4 - -- <br /> Domesdc welt on site- (y/a) & <br /> It yes, location and distance- R <br /> r' <br /> Holding Temperature <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/n) <br /> SPO <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted- (y/n) <br /> Storage Location Casing type <br /> Blank fL Screen K <br /> Slot size <br /> GROLMING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gmvcl <br /> Mix Ratios o = Filter Pack type/sue <br /> Installation Me&&d Surge Block: - (y/n) <br /> Quantity lnstallcd Discussed with geologist: - (y/ n) <br /> n <br /> EH 29 29 -SCh Type of method <br /> / l:W� <br />