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%iELD WELL COMPLETION FORM ❑CMRISTY BOX <br /> -- ❑ LJoe OCKING STEEL COVER <br /> HAM[; INCH DIAMETER <br /> z PROJECT y STEENG ONDUC70R <br /> Jos <br /> V:et[R: ��� �/ ""t,� MANAGER: /v' '� ` �' <br /> L0 <br /> 6.0E0 A y f� �/tel EDITED todeet <br /> BY: / •Y: <br /> Overs: INCH DIAMETER <br /> WCu ���✓— / /Z ZF `�� BOREHOLE <br /> NAME: <br /> DRILLING �. —to4e/ feet <br /> COMPANY: r'/G E /�'�'�771'�� <br /> �� DR�tcE SEONITE-CEMENT <br /> BOVIFMENT, <br /> INCH HOLLOW STEM AUGER - �' SEAL <br /> GR <br /> HOURS SE9L CEMENT—SAND <br /> ❑ INCH ROTARY WASH DRILLED: S 9L to / feet <br /> SALLON[OF NATER C <br /> USED DURING DRILLING: / GALLONS <br /> MRMOD OF DECONTAMINATION <br /> PRIOR TO DRILLING: //C 'T/ /C �y�c` TOP OF CASING AT <br /> /'FEET ASOVE;AT; <br /> DEVELOPMENT BELOW GROUND LEVEL <br /> i <br /> METHOD Or INCH DIAMETER <br /> DEVELOPMCNT, BOREHOLE <br /> DEVELOPMENT �j._t0�C Teti <br /> BEGAN DATE: TIME: <br /> YIELD. TIME: DATE INCH DIAMETER <br /> GPM FROM TO SCHEDULEAOPVC <br /> YIELD: TIME: DATE' BLANK CASING <br /> GPM FROM TO �/_ to"/£.S feet <br /> YIELD: TIME: DATE. <br /> GPM FROM TO BENTONITE-CEMENT <br /> YIELD: TIME DATE SEAL OR <br /> GPM FROM TO S-SACK CEMENT.SAND <br /> TOTAL MATER REMOVED SEAL <br /> DURING DcvcLOPMCNT: GALLONS �� to�feel <br /> DESCRIPTION <br /> orTURBIDITY ❑CLEAR D SLIGHTLY CLOUDY !! BENTONITE PELLET <br /> AT END of SEAL <br /> D[VCLOPMtHT: DMOD.TURBID DVERY MUDDY /",Sf <br /> tom eel <br /> coonor <br /> W <br /> AT,R: ...... <br /> WATER ❑GROUND SURFACE OTANKTRUCK SAND PACT <br /> DISCHARGED /�'S toL—feet <br /> to: ❑STORM SEWERS DSTORAGETANK <br /> DORUMS DOTHER ? <br /> INCH DIAMETER <br /> ot""TO WATER SLOTTED <br /> wrrcw D[V[IOPMENT: FEET InCh) SCREE, <br /> MATERIALS USED SPS <br /> 10—feel <br /> INCH DIAMETER <br /> ! - S PVC <br /> SACKS OF SAND NDULEANK SILTTT T <br /> BLLRAPAP <br /> SACKS OF CEMENT /to feet( �/- <br /> GALLONS OF GROUT USED BOTTOM WELL CAP <br /> SACKS OF POWDERED BENTONITE L�feet <br /> G� POUNDS OF BENTONITE PELLETS /HOLE CLEANED OUT TO <br /> � 1KI <br /> ZG FEET OF INCH PVC BLANK CASING <br /> BOTTOM OF BOREHOLE <br /> FEET OF—'?—INCH PVC SLOTTED SCREEN /{/. 5 <br /> i �IKt <br /> FEET OF INCH STEEL CONDUCTOR CASING <br /> VAPID CEMENTdAND IREDI-AI XI ORDERED NOT TO SCALE <br /> - YARD CEMENT-SAND IREDI-MI XI USED ADDITIONAL INFORMATION: <br /> CONCRETE PUMPER USED? &p40 DYES <br /> NAME <br /> WELL COVER USED: ❑LOCKING STEEL COVER <br /> OCHRISTY BOX <br /> MOTHER <br /> SI LT TRAP USED? NO DYES <br />