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ZIplYil Ul1UUIIV Environmental Health Department <br /> ,�. Monitoring Well/Soil Boring Inspection Report <br /> tot a L9 ry rn <br /> Y"/ <br /> UoN <br /> rarity Address: �� ,�� <br /> Well Aderes: zso a P'°t � Total oepm: <br /> well D o�i We11P: Drilling <br /> Soilfsmin¢9:_ '1em M22' M nAular EHDSual Vented: ❑ vg ONO <br /> Dd lingcnmpaud 3�— <br /> Duller a\1 Steel length Frons_ TO— <br /> romajitamn— _ <br /> - (yl. � so%L�""^AaL > FdorPeck From _ _ ._ To <br /> Geologist . _ gib _ _ - From -- TO - — <br /> Grant From <br /> TO- <br /> Public water system onsae: , n Yes nNo COMPLETION <br /> ❑ St Pipe Pe 120arybe gm <br /> Domestic Well CURIO: u Yes ONG <br /> —Dyes,—imam=and d nan<e. heF9ry <br /> Methond <br /> SAMPLING <br /> Screening Method: <br /> Verified (Amin ofCustodv Dyes own -�-6 <br /> SPOILJ <br /> Gartaninaftion uses ONO <br /> If sm <br /> ells Notedtorage Lomtion:townred Dyes UNQ <br /> GROWING or mamepin:_ 14o <br /> Dmpmowat'�E +sue —R <br /> .d- r h xwLsroEve <br /> Gallons or Grout Used: LOP <br /> Tmo: <br /> nwell Installation Dwell uestrp<tion Blank screen Feet_ <br /> ogonng Installation Pplamg Destruction <br /> METHOD USED Sand/Gravel <br /> DOusame Groot novorndll Tore/Brand 4Bentomte <br /> Filter <kType/size: <br /> ❑ Graven 2fenee Ebother Tyrre ofM <br /> away M�R� <br /> ullms was Rarm Own <br /> al Mee amba"it hux <br /> Them Inmos <br /> 4.7 <br /> W RL <br /> Al w µµq o9 11 Y 1 Ib b / trI N �PGaop <br /> 1�aE Nazanon v I if ie s20sIT' zo9a88aa201 F2n9rwo138 I vw . :mgdd <br /> it K, bb � SS4k on 9 11µ / 7D911"ai <br />