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Wr"' . "=== =`-== QA/QC Form <br />Well De i nation 14'4) <br />Date 6t Z 4$ <br />Inspector P. L. (era e? <br />Page 2 of 5 <br />2) Source of any water used for drilling: (? <br />SGNWAYrrZwfK-17E2 ?"?( Wk-rew_ 12E?o1eArr f''4)u-r <br />3) Name of any chemical additives or muds used: <br />'FAS`1- Mun sr CE rco /Aec- <br />C. Size and depth of well bore hole, type of drilling <br />1) Method used to drill well bore hole? <br />PCOYA-M A t.?_ <br />2) Nominal hole size? `0 r A1DM(AlAe- <br />3) Type of drilling used hie Q&Tojay 'T2( - mus -8rT <br />Drilled depth of hole?.-,20' <br />D. Piezometer casing and screen <br />1) Well casing and screen specifications. <br />a. Type of well casing and screen used? PVC-Ft-us 301NT <br />- <br />Reason other than P.vc casing and screen with screw join <br />was used: <br />b. Nominal diameter of casing and .,screen used?N? <br />Reason for variation from minimum,2= inch 'nominal <br />diameter: r <br />aA_iS-rr_ c(cz( W P LA i C, IA. Ft& (eAS?+v? o gue <br />.,1/V/rN n.r.rn,941DA-tC A nuMP F-Da QGCMP__MST: <br />2) Installation O1() 3 04441 s(o? scze <br />a. Length of screen installed? <br />Reason for variation from specified screen interval <br />b. Total length of casing-installed? 10.7 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 />Auk