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� ^ W <br /> -- [DUI'll TY--' <br /> MOn'tor'nRVVe|//SO'| Boring |nSpe{ƒ'OO QeDQ[f <br /> Date. Inspector:. POLA SO CONSTRUCTION <br /> Facility Address: s)'Tmc~� 2wuflm <br /> WellWellAddress: Tota| Depth:_______ °~ <br /> Vv Drilling Rig Type: <br /> Soil -Drilling Company: yWinZ. Annu|arEHDSea| Vehfied: [] Yes []No <br /> - �� ~- � � Screen From: � <br /> To� <br /> ".".". ".=`= -_---____ <br /> Consultant: Filter Pack From: To:_________ <br /> Geologist: Bentonite From: To:_________ <br /> Grout From: To:- <br /> Public Water System <br /> o:__________Pub|icVVaterSystem Onsite:� [] Yes []No <br /> C{X\11PJETl<}N [] Stovepipe [][hristieBox <br /> Domestic Well Onsite: [] Yes []No ` <br /> �c <br /> |fyes, location and distance: mecguc <br /> SAMPLING -1AZO/ �-- no ~nrn� D�9~ <br /> Holding Temperature:� rou=LErvzw o��on-+aox <br /> oca1FuEMom <br /> yWe1ho6' o"�:o�um�� .. <br /> � �3�-------~�� <br /> Screening Method: groutr <br /> Verified Chain ofCustody: [] Yes []No <br /> SPOILS <br /> Contamination Noted: [] Yes []No � <br /> |fyes,spoils storage Location: | � <br /> Covered: [] Yes []No --- / <br /> Ifyes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> � <br /> Depth to Water: U Al V <br /> Gallonsof Grout Used: t- IS?- 8.,qfta1qA <br /> Casing Type: <br /> []VVeU Installation []VVeU Destruction Blank Screen Feet <br /> ^ <br /> Slot Size: <br /> LJ8ohnQ|ns��UadonS]�«hnQDes�ucdon � <br /> �- Bags ofCement: <br /> METHOD USED BaOsSand/Grave|: <br /> Type/8randofBentonhe� <br /> []Pressure Grout OOverDrO| � <br /> FU�erPac�Type/�be�� <br /> � <br /> [] Grov�y []To�mie ra�°her� � TypeofK4ethod� <br />