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- ALZ.AT[ON REPORT <br /> MONITORiNG WELL INST <br /> CONSTRUCTION <br /> Date: <br /> Total Depth (to)_ <br /> Premise Address: Screen Length (from) <br /> Filter Pack (from) (,o)- <br /> Well No.: Bentonite (from) (to) <br /> Grout (from) (to)- <br /> Inspector. Drilling rig type <br /> Auger O.D. LD. <br /> Permit No. Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> casLng <br /> Driller': he a cht <br /> Driller': <br /> Consultant <br /> Geologist AW E-GRC(J ID a4ss TY-aox <br /> OOMPLETION ccGL>t=nON <br /> Gr nd Sutacs <br /> SPECIAL PERMIT INFO. gra.•t <br /> Distance to server line <br /> Domestic well on site .- (Y/ n) K, <br /> if yes,location and distance - <br /> v O <br /> _ O <br /> stone. d — <br /> SAMPUNG a4cicn <br /> Holding Temperature w= <br /> Method — <br /> Screening Method <br /> Tracking Shcet (y/ n} n, <br /> SPOILS <br /> MATERIALS EVELOPMENT <br /> Storage Method <br /> Contamination Noted- {y/n} Casing type fl. <br /> Storage Location gl h Screen <br /> Slot size <br /> Bags cement <br /> GRw OtMNG Buckets bentonite <br /> Begs sand/gravel <br /> Depth to water Filter Pack type/size <br /> Mian Ratios Surge Block: - (Y/11) <br /> 4tpstalladon Method Discussed with geologist: <br /> Quantity installed Type-of rnethod <br /> EH 29 29 <br />