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tte-g fAJA-06 <br />MONITORING WELL INSTALLATION III T <br />Date: <br />betit .thi/61.0,4ts cui-ek, Total Depth Premise Address:P.0.s . <br />Screen Length (from) (to) <br />Well No.: J1') 'b IP/ )I c ) 02-f,,D2S I b Tr I) 3 S / Filter Pack (from) (to) <br />Bentonite (from) (to) <br />Inspector: 4 (61•44-4( Grout (from) (to) <br />Drilling rig type <br />Permit No. g 72.77 <br />Drilling Company: (VO'CALAJC.A.J_ <br />CONSTRUCTION <br />Auger 0.D. I.D. <br />Completion - Stove pipe/christie box (circle one) <br />Driller: <br />Consultant ig—S <br />Geologist <br />SPECIAL PERMIT INFO. <br />Distance to sewer line <br />Domestic well on site - ( y / n ) <br />If yes, location and distance - <br />SAMPLING <br />Holding mperature <br />Method <br />Screening Method <br />Tracking Sheet - ( y / n ) <br />SPOILS <br />Storagf Method <br />Coat 'nation Noted - ( y / n) <br />Storage Location <br />casing <br />height <br />ABOVE-GROUND <br />CO tyiP LET ION <br /> <br />CHFI ISTY-80 X <br />COMPLETION <br />MATERIALS/DEVELOPMENT <br />Casing type <br />Blank <br /> <br />ft. Screen ft. <br />Slot size <br />GROUTING <br />Bags cement <br />Buckets bentonite <br />Bags sand/gravel <br />Filter Pack type/size <br />Installation Method Surge Block: - ( y / n) <br />Quantity Installed Discussed with geologist: - ( y / n ) <br />Type of method <br />I.AJ Depth to water try <br />Mix Ratios <br />EH 29 29