Samuel Stothoff Company, Inc

Questions to be Answered for a NJDEP Deviation Request for Monitoring Wells

1. The Purpose of the Well Construction:
2. The Location of the Well
Block #:
Lot #:
Municipality:
County:
Property Address:
Name of Monitoring Well:
3. Owner Information
Name of Owner:
Phone Number:
Address of Owner:
4. Name, Address, and Telephone Number of the Driller:	Samuel Stothoff Co., Inc. PO Box 306 Flemington, NJ 08822 Phone: (908) 782-2116
5. The unusual conditions existing at the Site:
6. The reasons that compliance to the rules for minimum standards will not result in a satisfactory well:
7. The proposed method of construction that the well contractor believes shall be adequate for each well:
8. A description of the pertinent features of the proposed well design and construction:
Case Manager:
NJDEP Case #:

59 Highway 31 • PO Box 306 • Flemington • New Jersey • 08822 • (908) 782-2116 • info@stothoff.com

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