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MONITORING WEU IN SrALLATIOM REPORT _ <br /> f <br /> Date: <br /> ti <br /> CONSTRUCrON <br /> Premise Address: z � <br /> Total Depth �p <br /> Well No.: <br /> � Screen Length (from) —(to) <br /> - r :"5� Filter Pack (from) (ro — �fno : Bentonite � <br /> (from) (ro)a <br /> Grout (from) --�— <br /> Permit No. DriilirsS rig type (to)�z <br /> Auger O.D. I.D. <br /> Drilling Company; Completion - Stove pipe/Christie bos <br /> (circle one) <br /> Driller: <br /> �,. casing <br /> Consultant ' height <br /> 4 'q <br /> Geologist <br /> AZCVE-GRLtJND <br /> SPECIAL PERMIT INFO. CckgL=T)ON CMS7Y-30X <br /> Grand sulaca -LTICN <br /> Disrance to leiver line <br /> Domestic well s' -.Cy/n ) prat <br /> If yes, ]ocatio d distance - <br /> 2-3 - fr. <br /> SA�NG <br /> C <br /> .HoldingTe <br /> mpera <br /> Method f <br /> Screen' d Method <br /> Tr ing Sheet (y/ n } <br /> SF� JLS <br /> Storage Method <br /> Conta-nination Noted - (Y/ MA-fERIALSmf OPMENT <br /> Storage Location - <br /> Casing type . 1L16, Ib <br /> � �S <br /> Blank jr- Screen <br /> G� Q-��-G .Siert size <br /> Bags cement fr <br /> Depth to water Buckets bentonite <br /> Mix Ratios Y, Bags sand/ <br /> Installation gra I'll,Method Filter Pack type/size <br /> Quantity Installed SurgeIock: <br /> iscusse vri <br /> EH 24 2th geologist: - {Y/V <br /> 9 <br /> Type of , tliod . <br />