Laserfiche WebLink
ENVIRONMENTAL RESOURCES MANAGEMENT <br /> ERM-WEST CHRISTY BOX <br /> FIELD Wn.L cobaLETION FORM ❑ LOCKING STEEL,COVER <br /> rob <br /> Nam.: J/e Owner � INCH DIAMETER <br /> STEEL CONDUCTOR <br /> Locatwo 7 _ ob it - <br /> CASING <br /> Project ` , to filet <br /> Ygg� /l � gyroIv[saaBCT.,NiG <br /> "- _INCH DlAfiilET£Fi <br /> BOREHOLE <br /> won <br /> Number Driller. �` to—feet <br /> Date of Installation; 9-1 [lours Drilled. BENTONITE-CEM9NT <br /> SEAL OR <br /> Equipment: 8-SACK CEMENTSAND <br /> Inch Hollow Stem Auger Inch Relays Wash PSEAL <br /> Gallons of Water +-/ to feat <br /> Used During Drilling f© Gallons <br /> Method of Decontamuratton }� lea vk TOP OF CASING AT <br /> Prior to Drilling ( 0° FEET ABQV A <br /> WeilPermittrel � V 1 _Issuing ABewr /4M <LBEZWGROUND L <br /> INCH DIAMETER <br /> DEVELOPMENT BOREHOLE,� <br /> Method of toYC0_feat <br /> Development: _ _ _ _ _ _ _ <br /> INCH DIAMETER <br /> Development - SCHEDULE 40 PVC <br /> Began DayG Time ' BLANK CASING <br /> Depth to Water to ALI <br /> Before Devoiopmeac Feet BENTONIT>=.CEMENT <br /> ld tint+ Date <br /> Sr- <br /> Y1 <br /> E <br /> YieAL-OR _ <br /> lFrowTo 8SACK CEMENT-SAND <br /> Yield. GPM <br /> 'I'itam Date; <br /> SEAL <br /> GPM Flout. To, ti> <br /> Total Water Removed BENTONITE PELLET <br /> During Development Gallons jSEAL rf <br /> Descriptionof te°�f"sinal <br /> Turbidity at End clear <br /> Q-Slsghdq cEe°dy <br /> of Development Mod Turbid Q Very Muddy wnY! ..uYaes. <br /> SAND PAC��K//� <br /> Odor of Water ` to-V—feet <br /> Water C—_l Ground Surface Q Tank Trach I NCH DIAMETER <br /> Discharged (M Storm Sewers IpStarage Tank SLOTTED 10-U 2-0 <br /> Ta ODrum= Q Other ,IInch)) SCREEN <br /> _ <br /> Depth w Water Data�me A245 to t"Z�feet <br /> After Developmemt Feet Well Devoiopment CampletW <br /> INCH DIAMETER <br /> Wen Elovaaoa Feet Measuring Polite(I e.Top of Caswgk SCH EDULS 40 PVC <br /> MATERIALS USED BLANK S�L�f T� AP <br /> 3� toL',� foot <br /> Sacks of - SendOTTOU_ <br /> 3�75"tot <br /> WELL CAP <br /> Sacks of Cement + <br /> Gallows of Grout Used HOLE CLEANED OUT TO <br /> Sacks of Powdered Bentonite fen <br /> Pounds of Bentonite Pellets BOTTOM OF BOREHOLE <br /> Feet of rmeh PVC Blank Casing 4!b—1=9 <br /> Factor Inch PVC Slotted Screen NOT TO SCALE <br /> Feet of Inch Steel Conductor Casing <br /> AOOITtONAL INFORMATION— <br /> Yard's Cement-Sand(Red&-Mix)Ordered <br /> Yards Cement-Sand(Reds-Mlx)Used <br /> Concrete Pumper Used? No Yat <br /> Name <br /> Well Cover Used. Locking Steei Cover <br /> Diversified Well Products Box <br />