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Piezometer QA/QC Form <br />Well Designation'Mtd-11 <br />Date +fl 1-1-7 <br />Inspector :P. L./TZen <br />Page 2 of 5 <br />2) Source of any water used for drilling: <br />3) Name of any chemical additives or muds used: <br />FtcAN4 4C.EM-1- Vies-hr- o" %-f C:E71co /A CL <br />C. Size and depth of well bore hole, type of drilling <br />1) Method used to drill well bore hole? <br />A(9 ? yoLUNt-kc,? NAt4 k812? <br />2) Nominal hole.size? 8". <br />3) Type of drilling used Rost, Z eu,k, F}o« AA8;t <br />Drilled depth of hole? 201' - Vim" f-dOr To ALL-! r-oIL SLuPF <br />CLe14jec 40L.E LUMS Ale. A+JO IM4CZ-reD FOAM-+riH -WA-yeYL p2ta2T0 ""3Ta.uc 10.Q <br />D. Piezometer casing and screen <br />1) Well casing and screen. specifications. <br />a. Type of well casing and screen used? PvC,. FLusi4, ao Pr ; . <br />Reason other than PVC casing and screen with screw joints <br />was.used: <br />b. Nominal-diameter of casing and screen used? ?n <br />Reason for variation from minimum 2 inch nominal <br />diameter: <br />WRN cAu yo Fo 2 4 <br />2) Installation -56AetAJ SLOT SIZE 1.5 V. 03 11JC,N <br />a. Length of screen. installed? So' <br />S8? ??,??mu ON Vab Reason for variation from specified screen interval <br />BO yo 14 <br />b. Total length of casing installed? %3o Number of <br />joints used? 4-5 <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 />AOL) <br />.,t ...,..e r <br />.;i :. :?L