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FIELD WELL COMPLETION FORM <br /> <br />MAM[+ <br />,p• f, rl D~:Ike a~ RPEIwEM <br />~O. -w0~[CT <br />C <br />wur.[w. 3 6 D• rAwAC[w: <br />C <br />~;acsD i:~T[D LA~ <br />L <br /> ~ <br />A <br />~ <br />HAM[ _ <br />~~ <br />IDA s <br />I <br />: ~ 1 <br />IO~,.~ 9 <br />CDriww ~: ~ <br />[ <br />~ <br />~ <br />~I <br /> r <br />~ . <br />iPy <br />1] 1^ <br />ylni ~ <br />[DUl-r[nT: U DwILLSw. <br /> LLOW STEM AUGER <br />_LL INCN HO <br />S <br /> q <br />®~ INCN pgtf,AAx,A1+E6N DwILLmr <br />G•LLO N! O/ WAT[R <br />V![O OYRIMG ORILL1Ma+ ~ A GALLONS <br />rRM00 0/ D[CO NTArIwA TIOw <br /> <br />-wrOw TO Ow LLLlnc. ~ ~~ <br />DEVELOPMENT <br />METHOD OI ~ <br /> <br />O[V [LO-r[wT: I~ <br />IH <br />O[V [LO-M[MT <br />•[o An OAT[: TIM[r <br />•I[LO: TIM[: OAT[: <br />GPM FROM TO I <br />. GPM IFROM TO ~ <br />YIELD: Tlr[+ ~ DAT[= <br />GPM (FROM TO <br />YI[lD: TIr[: IoAT[: <br />GPM FROM TO <br />TOTAL wAT[w wsrev [e <br />DYRIn6 O[V [l0 -M[NT: GALLONS <br />D[.Cwl /TIOw <br />o/TUwnDITT `IIJt QCLEAR ^SUGHTLY Cl000Y <br />D[V [LO-r[wr: QMOO. TURBID Q VERY MUDDY <br />ooow o- n' <br />wAT[w. V" I F'~ <br />wwr[w ^GROUND SURFACE ^TANK TRUCK <br />DtscrlAwccD <br />To! NI~ QSTORM SE WEBS QSTORAGE TANK <br />QDRU MS ^OTM ER <br />OL-Tw TO wwr[w N4~ a\ ^ ~ ~~ <br />AR[w O[V [LO-r[MT: 4' /` FEET <br />MATERIALS USED .jl~ -1 <br />SACKS OF 0 1~W0~ ~O/~.lf5e-QJ1a~NW SANG <br />SACKS OF ~J~tV+ `-f ~~i CEMENT <br />GALLONS OF GROUT USED <br />SACKS OF POWDERED HENTONITE <br />POUNDS OF BENTONITE PELLETS <br />I ~ ~. <br />FEET OF~INCN PVC BLANK C'AS LNG <br />~ p ~1 <br />_L~, FEET OF ~~ INCN PVC SLOTTED SCREEN <br />FEET OF ~I NCH STEEL CONDUCTOR CASING <br />YARD' CEMENTSANO IRED1~11 XI ORDERED <br />YARO~ CEMENT-SANG lREO1~AI XI USED <br />CONCRETE PUMPER USED7 ~NO AYES <br />NAME <br />wELI COV ER USED: ^LOCKING STEEL COVER <br />CCHRISTY eax N'~ <br />Q OTHER _ <br />SI LT TRAP USED? ENO OYES <br />N ~~ [CHRIy;Y sox <br />-~ <br />-1~ I C LOCKING STEEL COVER <br />_~ :NCH DIAMETER <br />S"E:L CONDUCTOR <br />CASING <br />_:D-••K <br />INCH DIAMETER <br />BOREHOLE <br />~:o~'er~ <br />BENTONITEL£MENT <br />SEAL GR <br />~~ BSAA` K CEMENTSANO <br />~:0~t~.i <br />NOTTO SCALE <br />T~FCASI T <br />FEET BOY AT; <br />9ElOW GRO EVEI <br />K <br />INCH DIAMETER <br />BOREHO~~LIIEee y~~ <br />:O~tM. <br />\~ <br />INCH OIAMETEA <br />SCHEDULE b PVC <br />BLANK CAS,I~.NG <br />~ to JO ~e.t <br />BENTONITELEMENT <br />SEAL OR <br />BSACK CEMENT•SAND <br />SEAL <br />'j SO `~ fM <br />BENTONI7E PELLET <br />SEAL <br />_ro_Hes <br />a: 1, ~~a.l <br />SANG PACK V <br />1~ to ~a fe.t <br />V <br />I NC HA~D"_I A~~ MM~E"_T1yyER <br />SLOTTED IQD <br />incnl SCA.EEN <br />to ~_te~t <br />INCH OIAME TER <br />SCHEDULE ~O PVC <br />BLANK SILT TRAF <br />Ito -feet <br />90TTOM WELL CAP <br />~~ ten <br />HOLE CLEANED OUT TO <br />_~fet <br />B~~OTppTOM OF BOREHOLE <br />tfl_ fe.t <br />AOOITIONAL INFORMAT{ON: <br />4o+t.ti ~ S 10 ~t~ <br />~~~~~~ - <br />