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- - M0Na0PJNG WELL INSTALLATION RESORT <br /> CON S—RU CTT ON <br /> Date, <br /> Total Depth <br /> Premise Address: Screen Length <br /> Filter Pack (frorn) <br /> Well No.: Bentonite (from)-° (to)�_..._ <br /> Grout <br /> Inspector*. <br /> Drilling rig g type I.D. <br /> Auger O.D. cluistie box (circle one) <br /> Permit No. Completion - StoVe PiPc/ <br /> Drilling CompanY� casing <br /> height <br /> DrilleIFM <br /> r• <br /> Consultant <br /> Geologist SAYE-G�CUt•ID C},A:SiY-30X <br /> COMPLETION r�t'T1GN <br /> Cgwnd Sulact <br /> SPECIAL PERMIT 1NF0. flratt <br /> Distance to sewer lin �ft. <br /> Domestic well on <br /> site.-(y/ n) ft. <br /> If yes,location and distance <br /> r P <br /> O <br /> a <br /> SAM—PLIN G sodcn '.Y -- <br /> pzwl paac <br /> Holding Temperature <br /> Method Y. <br /> Screening Method( <br /> T`racking Shcet - y <br /> SP, 01 IS <br /> �_- - � � MATERIALS EVE[OPN[6NT <br /> Storage Method <br /> Contamination Noted (y/In Casing type f <br /> Storage Location Blank-----• fc. Screen <br /> Slot size <br /> Bags cement <br /> GREG puckets bentonite <br /> Bags sand gravel <br /> Depth to water Filter Pack type/size <br /> MIX h to Surge Block: - (y/n) <br /> 4pstallation Method Discussed with geologist: - {(y/n <br /> n <br /> Quantity Installed Type of nedzod <br /> EH 29.29 <br /> w� <br />