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-Wj: QA/QC Form <br /> Well D_ e i nation P•W`5 <br /> Date <br /> Inspector <br /> Page 2 of 5 <br /> 2) Source of any water used for drilling: <br /> Uk-r-em AzA-r i eX�r PLi-w-r <br /> 3) Name of any <br /> chemical additives or muds used:: <br /> •Fi�SY- Nun BY G€-rco/Ace- <br /> C. Size and depth of well bore hole, type of drilling <br /> 1) Method used to drill well bore hole? <br /> ER,v <br /> 2) Nominal hole size? 10'v 'A1o,4rrNAz <br /> 3) Type of drilling used /�t. P-&Z '-rec-GONG BtT <br /> y Drilled depth of hole?. . 2-01 <br /> D. Piezometer casing and screen <br /> 1) Well casing and screen specifications. <br /> a. Type of well casing and screen used? PVC- FLUS JcrNT <br /> Reason other than PVC casing and screen with screw joint.;' <br /> was used: <br /> b. Nominal diameter of casing and ,screen.;used? � <br /> Reason for variation from minimum-,2 inch :nominal <br /> diameter: <br /> Ur.,-rc c t J PLC C --LLAFD Fog (c CASIAJC 12 0 <br /> Gp EAATE A PuMP2 Auld TEST <br /> 2) Installation O t 03 + <br /> a. Length of screen installed?_ Ab <br /> Reason for variation from specified screen interval <br /> b. Total length of casing-installed? Jp•?� Number of <br /> Joints used? I <br /> Was sufficient casing installed to reach from total depth <br /> of hole to within one foot of top of surface casing? <br /> yes ✓ No Reason for variation: <br />