Notification of Ch 3 Monitoring Well Installation

Utilize this form to report to the WDEQ monitoring wells being installed under WQR Chapter 3, Section 8 that are not otherwise part of a WDEQ regulated facility or project.

Enter the name and contact information of the company the wells are being installed on behalf of.

Enter the location of where the wells will be installed. Include a facility name (i.e. Quick Fuel Depot) and address information.

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As part of this project, how many wells will be installed?

Enter proposed IDs for the monitoring wells.

Estimated date the installation activities will occur.

Provide the company, name, and contact information for the well installation company.

Provide the name and contact information of the person reporting the well installation to the WDEQ.