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QA/QC Form <br />Well Designation MW-Op • <br />Date 1017-9 qe <br />Inspector P. L. N+rse..j <br />Page 2 of 5 <br />!) Source of any water used for drilling: <br />.SGNw?.fz.-??wRt.pE2 I?'?i,v? Lda.r;,,? Tie?s?rMEUr P!1}iu'T <br />3) Name of any chemical additives or muds used: <br />Ef+'sy MUtp <br />C. Size and depth of well bore hole:, type of drilling <br />1) Method used to drill well bore hole? <br />Ro7A,r?Y AAA- i -Ar)jD 'D o w u W-O L S "A NcEn <br />2) Nominal hole size? 8Y <br />3) Type of drilling used !Zo-r 2 ; T,e r-csvN? ?!T <br />Drilled depth of hole? <br />D. Piezometer casing and screen <br />1) Well casing and screen:specifications. <br />V? - ?.03?wu-t st, <br />a. Type of well casing-.and screen used? <br />Reason other than PVC casing and-screen with screw joints <br />was used: <br />b. <br />Nominal diameter;of.casing,,a.,:screen used?;,, <br />Reason for variation from ;minimum 2 -inch ,nominal <br />diameter: ' <br />4 <br />! i <br />2) Installation , <br />a. Length of screen-installed? <br />Reason'for variation from specified screen interval <br />S EEO . C Ec.t s t av M R v E- C-M i t t3R-xfrNG Suet-l L?'? ? 7Ff . <br />?-': <br />b. Total length.of casing-installed?- 20- Number of <br />joints used? Z <br />Was sufficient casing installed to reach from total depth <br />?? ©Fr of hole to within one foot of top of surface casing? <br />OF A 10?:101l•J7 Yes ? No Reason for variation: <br />- An