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0 TETRA TECH EM INC. MONITORING WELL INSTALLATION RECORD . <br /> FLUSH MOUNT INSTALLATION <br /> WELL LOCATION INFORMATION COVER <br /> WELL NO. _ �+`1' l g� WELL CAP <br /> BOREHOLE N O. Q� HEIGHT OF WELL CASING <br /> SITE (� ELEVATION TOC <br /> SUBSITE �r+-- <br /> DATE 81?s�� GROUND <br /> ELEVATION <br /> RECORDED BY M B�rJl4�c` <br /> WELL PERMIT NO. <br /> SLOPED CONCRETE PAD 1 SURFACE SEAL <br /> SURFACE COMPLETION INFORMATION GROUT <br /> TYPE OF INSTALLATION DEPTH TO TOP OF GROUT 5vv4.c.eL <br /> ❑OPEN HOLE GROUT FORMULA(PROPORTION OF EACH) <br /> INSIDEHOLLOW'STEM AUGER CEMENT to 1►yBENTONITE <br /> TYPE OF FLUSH MOUNT WATER � OTHER <br /> _ QUANTITY USED <br /> 14 CHRISTY BOX ❑ PREPARED MIX <br /> ❑ -NAME OF PRODUCT <br /> ❑LOCKING COVER MANUFACTURED BY <br /> SWATERTIGHT CAP QUANTITY USED <br /> YLOCKING CAP TYPE OF CASING <br /> SURFACE SEAL []STAINLESS STEEL CASING DIAMETER <br /> Q NON-SHRINKING CEMENT •®.SCHEDULE 40 PVC INSIDE <br /> SCHEDULE 80 PVC OUTSIDE % <br /> VICONCRETE <br /> ❑ <br /> 1:1 El <br /> � <br /> MANUFACTURED BY <br /> ❑CHECKED FOR SETTLEMENT DEPTH TO TOP OF BENTONITE SEAL <br /> ❑INTERNAL MORTAR ADDED BENTONITE SEAL PELLETS Cl SLURRY' <br /> ROUND SURFACE ELEVATION POWDER/GRANULAR ❑ <br /> QUANTITY USED <br /> [] SURVEYED DEPTH TO TOP OF METHOD INSTALLED <br /> DATE FINE SAND COLLA []TREMIE <br /> POURED ❑NOT USED <br /> MEASURING POINT <br /> ❑TOP OF WELL CASINGDEPTH TO TOP OF FINES Ze ND COLLAR(OPTIONAL) <br /> TYPE <br /> ❑GROUND SURFACE ��✓ FILTER PACK <br /> FILTER PACK <br /> DEPTH TO TOP OF GRAVEL SIZE � TO FT. <br /> TO <br /> SAND SIZE —7•—, — <br /> DRILLING INFORMATION 17 SCREEN QUANTITY USED � Fr. <br /> � <br /> DRILLING COMPANYIPERUQNNEL FORMATION COLLAPSE; TO FT. <br /> v MATERIAL <br /> METHOD INSTALLED <br /> TREMIE <br /> DRILL RIG 17 CENTRALIZERS POURED <br /> DRILLING METHOD p YES AT GRAIN SIZE TESTS FOR FILTER PACK <br /> R HOLLOWSTEM AUGER ❑CONDUCTED;FOR REPORT.REFER TO <br /> ❑AIR ROTARY ❑STAINLESS STEEL J�NOT CONDUCTED <br /> ❑MUDIWATER ROTARY TYPE OF SCREEN <br /> ❑ I5il NO []STAINLESS STEEL SCREEN DIAMETER <br /> DRILLING PE_E��Gqa� �N�N�,,, DCPTH TO BOTTOM SCHEDULE 40 PVC INSIDE <br /> DATE V15/ ..'TIME 10 OF SCREEN ❑❑SCHEDULE 80 PVC OUTSIDE 2_ + <br /> WELL COMPLETION BEGAN DEPTH TO BOTTOM SLOT SIZE <br /> DATEy'z5jjgTIME 1070 �s OF CASING MANUFACTURED BY <br /> WELL COMPLETION FINISHED DEPTH TO BOTTOM <br /> DATE B/ZG/gBTIME 730 FILTER PACK — BACKFILL MATERIAL <br /> DRILLING FLUID TYPE =3I I=I I I- Cl GRAVEL 0 FORMATION COLLAPSE <br /> ❑BENTONITE ❑WATER2lJDEPTH TO BOTTOfYI —III C]BENTONITE MATERIAL <br /> C]POLYMER ❑- OF BORING -� E]SAND <br /> DRILLING FLUID LOSS <br /> ❑YES GALLONS TOTAL LENGTH OF �cJ <br /> CASING AND SCREEN NOTES: <br /> WNO <br /> ATER ADDED DURING COMPLETION DEPTH TO WATER 1.SCALE:NONE <br /> 'm YES_jQ –GALLONS FOLLOWING 2.RECORD DEPTHS/LENGTHS IN TENTHS <br /> INSTALLATION(TOC) OF FEET,NOT IN INCHES <br /> ❑NO S TO FORMATION 3,RECORD CONSTRUCTION i5 T8548 14078 <br /> TOTAL FLUID LOS <br /> MIAUCYCD nC nnDr-Wr)l P $ ►� BELOW GROUND LEVEL <br />