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Wes' Pleac-titer QA/QC Form <br />Well Designation Mw-S,Pf? <br />Date io `3o/9B <br />Inspector P• G. tJ1e,en <br />Page 2 of 5 <br />2) Source of any water used for drilling: <br />?AR TZ W A LV EQ M wa f.J -nm _Tagx rm Eou? PLANT <br />3) Name of any chemical additives or muds used: <br />F11A&AtM6 AGEl.+T : VERSA FOAM 6Y CETCa `ACC <br />U?-'f Mupw Atso 431f C'ETCO(4CC- <br />C. Size and depth of well bore hole, type of drilling <br />1) Method used to drill well bore hole? <br />2) Nominal hole size? 8 " <br />3) Type of drilling used . Q. P_o-rp a.? fiftmmEe <br />Drilled depth of hole? '16' <br />D. Piezometer casing and screen ENVIao"Mewr&_ mr-G. J.,a <br />1) Well casing and screen specifications. <br />.,a. Type of well casing and screen used? "pVc -:F <br />uaso Jet" <br />Reason other than.PVC casing and screen with screw joints <br />was used: <br />b. Nominal diameter. of casing and -screen used? _.q 11.1 Reason for variation from minimum 2"inch nominal <br />diameter: <br />2) Installation Sce ?c.o c sizE ?? ?. 03 INCH <br />a. Length of screen installed? 10' <br />Reason for variation from specified screen interval <br />b. Total length of-casing installed? 9.5' Number of <br />t 4;(;t sol'?d 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 v' No .Reason for variation: