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RAP Section 4 <br />Injection and Withdrawal Wells <br />WELL QA/QC FORM <br />Well Designation r1. <br />Date 17-? g9 <br />Inspector oral: z- C16YeV <br />Page 1 of 6 <br />Injection and Withdrawal Wells <br />I. Coll ection and Recording of Lithology Samples <br />A. Handling and description of cuttings; samples: <br /> 1) Collected at 5-foot intervals from surface to total depth of <br /> well? Yes No Reason for variation <br /> <br /> 2) Name of geologist describing cuttings? <br /> 3) Was a sample log prepared during drilling of well? Yes J No <br /> Reason for variation <br /> <br /> <br />JI-.,::,Well :Construction :. <br /> <br />?..j : A. Dri 11 i ng f1 uids': <br /> 1) Type(s).of fluid used and interval(s) ?`Ol?` <br /> <br /> 2) Source' of Any water , used for °dr i 11 i ng lff T' <br /> <br /> <br /> a) Is Source Approved?. Yes No. <br /> 3) Name of any chemical additives or muds.used. <br />a) Were approved biodegradable muds used (Revert)? <br />Yes No Reason for variation <br />B. Size and depth of well bore hole, type of drilling <br />1) Method of drilling used 6.A?? <br />A-2 <br />