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��_ v �uiioNNuuln Environmental Health Department <br /> TY— <br /> G. Om s , LEM <br /> ,e. Monitoring Well/Sail Boring Inspection Report <br /> Date: I ew t %ameor. l.. NSIRUCTION <br /> amlaypmres: 'loon R.Y, A� _ 1J <br /> Wall nddreas: 34r adw e.J Total Depth: <br /> Pn. emu—! weir¢ on ._ <br /> bil Bonngx:, 'lo mmlar EHD seat Verrfie To <br /> ❑ Yes ❑No <br /> Prnimenshe r. _ S '" <br /> lann <br /> onner da:M"06Y — situ <br /> c ologisrt Buntarmite From. TEE <br /> eWpt From: To. <br /> PUNic Water Sysam ()mite: ❑Yee ONO COMPLETIONO Stove Pipe Oflrinsne Box <br /> Dannaticwell Monte: ❑ Yes ONO <br /> If yes', mention and distance: HR=sn <br /> FbilfingTemperattme, comeDzBou <br /> CONPULTUO <br /> method g Meth snn ® <br /> Sueeni <br /> wVm <br /> Verified Gainof LLstody: Ayes ONO 0. <br /> SPOIB <br /> Conminumbon Notts: Oyes ONO _ $� <br /> Ifye:, sPolls rtorage Wation:,, _ —R � } — '� <br /> Covered:mom ❑ Yes ONOIfyes, <br /> rn n Total Depth-Jp0 � <br /> Di <br /> ftoo water:GROUIRING or Esrxu o <br /> tarat :�� nEs/DEvs <br /> Umn of Boom Used _ "'v <br /> ❑Well Installation OWell Destructian Blank Casing Ty Summit _ _ Feet <br /> Droving installation higc�ng Deabrumion BapisofCenpSlOtSee <br /> ADD — - <br /> _. Snd/Gravel: _ <br /> peesre Grout OoverrnA Type/Brad of Bnumlte. _ <br /> HifterFackType/51w: <br /> ❑ Grassy PTf ie umber _ _ Type cif Method.__ <br /> _ _ pMal rn. ax wl� sc nn: <br /> Ile 41 is Ls y'N+d <br /> 1 W F. HavdanAa m m I nimpmn. cauamiaas7DG I r- zm 46a6420 I E zoB 46TTI M I .w,•,.Saalw <br /> IZ v1Itb"V /,Bg H„o III II ail j6 w I qD5 �,� <br />