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Piezometer QA/QC Form <br />Well Designations W -If <br />Date to /30/ ?.s <br />Inspector F, L . 10',e S <br />Fr-1VI zo+rL Page 4 of 5 <br />V(PLa(-A% &U,*gLW c • t grout specifications <br />bK co ?ACC i) Number of sacks of ees r xused? q i <br />6 "-T <br />-20 MEsla U ? ii) Number of gallons of water mixed with ee irt? ZA0 <br />iii Was clean fresh water used? Yes ? No <br />E) Well head protection <br />1. Type of casing used? STceL PIPE <br />2. Dimesion of casing? 8 9koMeTe'Y- <br />3. Length of casing placed in surface hole? <br />a) Is casing of sufficient length to extend a minimum of l <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 />10 <br />F) Well:-', Development <br />1. Length of time cement was allowed to cure after cementation <br />of well casing was complete? hrs <br />2 . -Development using ^,,,.n^ ` ^e'° balllngr- <br />:a) Length of time necessary,. to develop well (minimum of.one <br />hour) ? x ?? s <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 />?I l ? ? Q$ 'DTW N (10? - Dexe.?pP?? <br />I^awr`RZv 19al or pipe INYO iss wrz( .. bu2twYCr F?eSY IS '"W au7 4 Gfle4s gMOuN7 OF <br />1;-)p4-ree. FiLo,4 IS To 10"li. Ft?ow S"WED PI>WWi gLI En,o or- 300-AW. FLOW Yo LESS THAN <br />gPw?. I fFoc+iZ, FZom S-rAO-T of DCVew,PNeeur, TtMeo FLOW fr-T 9.'? 4PM. SHuT Dow+,J <br />?,(Z tN•tEt?1ou f}T (ti`4,iR .IStiuN ?ANo LAC weu? QeGOU?(? t=o2 pSMIN• Ttft7J BcGAvt7 4vrw?v-rlcrJ <br />At& b Low tjJAS A-r APP"` %t-tptREC-Y xQPrH Fe2 S-ro (?rHIN. Tf?M $LOweD 140 z G1°H- <br />I x(2.0-t11?A"rED bE'11L'I1?PH?Z ?-? •? t-4f2.5 F/tbr( STA-/L'7 <br />6,