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ENVIRONMENTAL. RESOURCES MANAGEMENT <br /> ERM-WEST <br /> • FIELD WELL COIUI.ETION FORM CHRIST 19QX <br /> sob �I ❑ LOCKING STEEL COVER <br /> N. hZ FMCY Ownwir r � INCH DIAMETER <br /> y <br /> lob ,, 7j7 -�n STEEL CONDUCTOR <br /> CASING <br /> Lugged Ravurwed Project + —to—fan <br /> HY �/'- BIr �'r Manage d 1/ <br /> "-- INCH DIAMETER <br /> Weq o)1 �. � BOREHOLE <br /> Number _(-4 W ` Driller to feet <br /> Date of Installation: 9-19— Hous Drilled: BENTONITE-CEMENT <br /> Equipment: SEAL OR <br /> Each Hollow Stem Anger Inch Rotary Wash B-SACK CEMENT.SANO <br /> SEAL <br /> ins of Water ^— to font <br /> Used During Dn7lum /O Gallons; <br /> Method of DecontzmrnatwnTOP OF CASING AT <br /> Prior to Drillmr,_, -C Q w. C lee't-, <br /> r I L')'Z-57- FEET ALiDV <br /> Wali Permit 0: � ���iIssuing Agencyr�6r+l Jr5l19Lt lye�olnT�[^ < ROUNO WEL <br /> DEVELOPMENT INCHDIAMETERDIAMETER <br /> BOREHOLE <br /> Method of Q to 1 Q fart <br /> Development: <br /> INCH DIAMETER <br /> Development <br /> Began Date" Time: BCLAENKK CCAASIN PVC <br /> BLANK <br /> Depth to water "�� to2LIZEfeet <br /> Before Development Feet <br /> BENTONITE-C1~MENT <br /> Yield: T'ima: Dam SEAL OR <br /> ,PM ram: To B.SACK CEMENT-SAND <br /> Yield: TimC Date: S��s��EAL` <br /> GPM From: To L-6S�t,,2E- feet <br /> Total Water Removed BENTONITE PELLET <br /> Dunag Development Gallaas <br /> SEAI- <br /> Description of p2S S to j7 feet <br /> Turbith y at End Q Clear Q Slightly cloudy ) <br /> Of Development: Q plod.Turbid Q Very Muddy wars ��M�sw <br /> SAN_O PACK <br /> Odor of Water <br /> `� taAtL Feet <br /> witru C:j Ground Surface Q Tank Truk INCH Of AME TER <br /> Discharged ©Storm Sewers =Storage Tante <br /> TO: Q Drums Q Other SLOTTED ( d" <br /> inch) SCREEN <br /> Depth to water Date/Time L Z�to 15 fee r <br /> After Development Feet Well Development Complctc <br /> Well Elevanoo Feet Megsnrmg Point(r.e.Tap of GUMS I HCH Of AMETER <br /> i SCHEDULE 40 PVC <br /> MATERIALS USED i `LANK Sl T-�TTRAP <br /> Sacks oftoy fees <br /> Send <br /> Sado of Cement37,7�f WELL CAP <br /> Galium of Grout Used <br /> HOLE CLEANED OUT TO <br /> Sacks of Powdered Bemmnrte ("t <br /> Pounds of Bentonste Pallets 14 BOTTOI44 OF BdREHOL.E <br /> Feet of ruh PVC Blame Casing foes <br /> Feat of Inch PVC Siormd Screao NOT TO SCALE <br /> Feet of Inch Steel Conductor Casing <br /> Yards Cement-Saari(Meda-INiri)Ordered ADDITIONAL INFORMATION: <br /> Yards Cement-Sand(Reda-Wi)Used <br /> Concrete Pumper Used? No Ya <br /> Name <br /> Well Cover Used: Looking Steel Cover <br /> Diversified Well Products Box <br /> Christy Box <br /> (]eh.� <br />