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. F' <br /> wF.L QA/QC Form <br /> Well De i ation <br /> Date Et U3 <br /> Z �8 <br /> Inspector -l. • ea�+� <br /> Page 4 of S <br /> c. Neat cement grout specif• ations <br /> i) Number of sacks of cement used? <br /> ii) Number of gall s of water mixed with cement? <br /> iii Was clean f esh water used? Yes No <br /> E) Well head protection <br /> I. Type of casing used? 11D S-16C- <br /> 2. Dimesion of casing? tO" <br /> 3 . Length of casing placed in surface hole? <br /> '022 0� 10-a"` %5 a) Is casing of sufficient length to extend a minimum of 1 <br /> ,asdriveh I%DU foot and a maximum of 2 feet above the ground surface? <br /> Yes -/ No _ Reason for. variation. <br /> )aq, C9o►StrIlC�tHn ` E� <br /> �•i � 0 `'''gr°°s F4"b) - was a single length .of surface casing used? Yes .� .:No <br /> =(t &i If not -were joints 'welded? Yes No _.._ <br /> F) Well Development <br /> I.. Length of time -cement was allowed to cure after- cementation <br /> of well casing was ,complete? .2M hrs <br /> 2. Development using surge block and bailing. <br /> ;a) Length of time necessaryto develop-well .(Minimum of one <br /> hour)? 1 Ig <br /> b) Was development continued until, clear water <br /> w with <br /> s no, <br /> fines._was produce. � o <br /> Yes . <br /> what is reason for.-discontinuing development. <br /> 4o <br /> p G.rL*i <br /> G�ac�,¢.Z ��'►�q O-�IG�ea�Jn.�a/tiT �' S�•cl i�.e� � $ 1 <br />