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SAGE-OF <br /> MONITORING WELL INSTALLATION REPORT <br /> Date: CONSTRUCTION <br /> Premise Address: "cam Well No. <br /> Inspector• Total Depth <br /> Screen Length S� <br /> Filter Pack bc.C� <br /> Bentonite Pellets <br /> Permit No. a �- Grout <br /> Consultant vj-e�r r i Assyc, Completion ove pipe/christie box <br /> Geologist D V(i <br /> Auger O.D. <br /> Auger I.D. <br /> SAMPLING <br /> Holding Temperature <br /> etk*-up <br /> Method <br /> Screening Method T <br /> ABOVE-GROUND CHRISTY-BOX <br /> Tracking Sheet (y/n) COMPLETION <br /> COMPLETION <br /> Ground Sumacs <br /> SPOILS <br /> grout <br /> Storage Method . <br /> Contamination Noted - yes/no �• <br /> Storage Location �. <br /> a <br /> a <br /> SPECIAL PERMIT INFO. = c <br /> A <br /> slotted <br /> Distance to sewer line section "- <br /> Domestic well on site - yes/no _ 9W P <br /> ack <br /> If yes, location & distance <br /> GROUTING <br /> MATERIALS USED: <br /> Depth to water Casing type <br /> Mix Ratios Blank ft. Screen ft. <br /> Installation Method Slot size <br /> Quantity Installed Bags cement <br /> Buckets bentonite <br /> Bags sand/gravel <br /> Filter Pack type/size <br /> Total Billed Time Per Site <br /> Date Permit Finalized <br />