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SARd0A0UIN <br /> �) Environmental Health Department <br /> COUNTY— <br /> Greatness grows here. <br /> /n Monitoring Well/Soil Boring Inspection Report <br /> Date: `'�/ Inspector: I C-?— / 01-- CONSTRUCTION <br /> Facility Address: J <br /> Well Address: 30 of12 ret Total Depth: <br /> WP# 00 LY0010 Well#: Z Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company; a Z C Min 2"Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: �� � Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: 111 <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWLETICN COMPLEMN <br /> Method: Ground Surf=* <br /> Screening Method: grkxrt <br /> Verified Chain of Custody: ❑ Yes El No �tt• <br /> n. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> C <br /> If yes, spoils storage Location: stoned _ B <br /> sac: <br />