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W.., , __eee -• ==-- 4A/4C Form <br /> Well MW-rO <br />Designation <br /> Date _ <br />1,0 /,'L3 (Q E <br /> Inspector P, c., r,i«s?n <br /> <br />YoJ,CLAYCiZNN13LE5 #cg <br />EHVt2oNntt'IJTf?e- Page 4 of 5 <br />C15TCO ?q c c. <br />10 Neat '_z° ert grout 'specif'ications <br />1 <br />Y <br />8-Zc MJ to ?a uc?e i) Number of sacks of aem?-t used? <br />GJLawT M I X 14 SACKS <br />1 <br />" <br />?errrcwrrE ii) Number of gallons of water mixed G?uT <br />with <br />snt? 3SQ?I.?,,S <br /> iii Was clean fresh water used? Yes No <br />E) <br />F) <br />Well head protection <br />1. Type of casing used? 8 STE?? <br />2. Dimesion of casing? <br />a ., 104.0E''OIAMK to-r& M <br />3. Length of casing placed in surface hole?. 5 <br />a) is casing of sufficient length to extend a minimum of 1 <br />foot and a maximum of 2 feet above the ground surface? <br />Yes _ No - Reason for variation.... <br />b) Was a: single length of surface casing used? Yes ? No _ <br />If not were joints welded? Yes No <br />Well Development GP-OLAT. <br />1. Length of time Leme nt was allowed to cure after <br />of well casing was complete? 2 4 krS <br />2. Development using Gur-ge a) Length.of time necessary-to develop::.well',(minimum.of one <br />hour) ? <br />b) Was development continued until clear water with out <br />fines was produce? Yes ? No If answer is-no, <br />what is reason for discontinuing development. <br />11(4 (48 DTw - 72.35' ;+ <br />n <br />T?. wo. , bs`t?w? o? well s art ?0 4s e wa . ti. -)-w ?x A w?1?a <br />tasGl c r?:r,5 o 1 lair l?. a ?, 5wa?? o,.., taw ?ro «,, w .a 44,a, <br />W2?A C?,-ca ?. lSw+?• J' &A4 l.(?W-s 140 rQ- .v wc+s /dee4JQe1 Z- L"t1. <br />