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ENVIRONMENTAL RESOURCES MAVGEMENT <br /> ERM-WEST KCHRISTY BOX <br /> FIELD WELL <br /> • <br /> COMPLETION FORM J i LOCKING STEEL COV <br /> E <br /> R <br /> lob PG -PtC 'L a INC- DIAMETER <br /> Name Owner- STELCO3DUCTORLocation ]ab or 7,2 CASING <br /> Logged Reviewed� P to—feet <br /> � er�' Manage <br /> Br— <br /> tOINCH <br /> DIAMETER <br /> well /� BOREHOLE <br /> Number ! ` 3 Driller L� 9 to 5 feet <br /> Date of Installation. O Hours Drilled BENTONITEZEMENT <br /> SEAL OR <br /> Equipmene �C Qr -5- 8-SACK CEMENTSAND <br /> UU Inch HollowStern Auger Inch Rotary Wash Z <br /> Gallons of Water D EL- to feet <br /> Used Dnrrng Drilling_ Gallons: <br /> Method of Decontamination 5 le-4-y.k L IUo�61 TOP OF CASING AT <br /> (� <br /> ynor to Drilling.ug. ( T FEET ASOVEIAT)5-6 2(v Issuing Agency )�h VbCi (ti h �u�4 AGROUND LEVEL. <br /> Well Permit W <br /> INCH DIAMETER <br /> DEVELOPMENT BOREHOLE <br /> Method of <br /> to.�O f eet <br /> Development 2 <br /> INCH DIAMETER <br /> Development SCHEDULEt'40 PVC <br /> Began Date: Timms LANK CASING <br /> -Z 5- <br /> to 3?11157 fbei <br /> Depth to Water <br /> Before Development Feet <br /> BENTONITE-CEMENT <br /> Yield Tima ]}atm SEAL OR <br /> .PM From To 8SACK CEMENT SAND <br /> SE <br /> Wield Time 0, �to 3Z Feat <br /> GPMFrpt>L 70 <br /> . Total Water Removed BENTONITE PELLET <br /> During Developmeas Gallons f SEAL <br /> Description of 3z to// <br /> Turbidity at End Clear [] Slightly cloudy <br /> of Developmenr [] Mod.Turbid Q Very Muddy Atj .urww. <br /> 7 AN aaf_K <br /> Odor of Water > � to feet <br /> Water Q Ground Surface p Tank Truck INCH OI AMETER <br /> Discharged © Storm Sewers [,=Storage Tank — 0,010 <br /> SLOTTEDi <br /> TZ Q Drum: fl other inch1ASCE " <br /> Depth to Water ]hte/Time to " feet <br /> After Developmene Feet Well Development Complete <br /> INCH DIAMETER <br /> Well Elevation Feet Measuring Point(i a Top of Casing) SCH EOULE 40 P VC <br /> 13 AP <br /> MATERIALS USED € / t15TR <br /> feet <br /> Sada of Sand <br /> BOTTOM WELL GAP <br /> Sada of Cement .5 0 feet <br /> Gallons of Groot Used 116 HOLE CLEANED OUT TO <br /> Sacks of Powdered Bentonite fan <br /> Pounds of Bentonite Pellets L BOTTOM OF BOREHOLE <br /> 5 <br /> Feet of Inch PYC Blank Casing d het <br /> Feet of Inch PVC Slotted Screen NOT TO SCALE <br /> Feet of Inch Steel Coad—,r Casing <br /> ADDITIONAL INFORMATION:-�--•^—� <br /> Yards Cement-Sand(Reda-Mil)Ordered <br /> 0—Yards Cement-Sand(Reda-Mix)Used <br /> Concrete Pumper Used? No Yes <br /> Name <br /> Well Cover Used, Locking Steel Cover <br /> Diversified Well Products Box <br /> Christy Box <br /> Other <br />