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' .` <br /> � 8 � U�&�#Y� � } �������������� Health Department <br /> ��0�������WI I, Environmental~,, , , ~,� _ , <br /> ---[0UNTY~-- <br /> Gno/xou �mns ^e^� <br /> M8OitOriUg \8/eO/S#H Boring Inspection Report <br /> '°A insyect so d'� <br /> CONSTRUCTION <br /> Facility A�----s Total Depth: <br /> ,"=""""'^^': DriUiogRig Type:—� �c�|VerK�d� []Yes El No <br /> SoUBn�ng#- &1inZ«Annular EHD <br /> Drilling Company. Screen Length Fr000�-----_' /»:---------- <br /> Uh||er0nude, Filter Pack F»ono�--_�--' T».----�----- <br /> Consultant: Bontunke Frooa:_______ /o:------______ <br /> Geo|o{jst: Grout From:— |«:----------' <br /> [][bhstieDox <br /> 0 it�� F]Ye� []��v LJ5toxePipe <br /> Puh\icVVn1crSys�enu n� � ����������� <br /> El []��o ��9 u o <br /> Donoe�dcVVeUUn�ite� oue��u+ <br /> |fye�|ncadon and d�tun»e: <br /> W <br /> SAMPLING COWLE110H COMPLETION <br /> Holding Temperature: <br /> Method: <br /> Screening Method: <br /> Verified Chain of custody: []Yes LJNo <br /> Contamination Noted: []Yes El No <br /> If yes, uwn*d <br /> ' � <br /> OYes ' []NoP� <br /> Covered: _ <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total 0epth:AQ�����/ ' �� <br /> Depth tuVVotec <br /> Grout Material: <br /> Gallons of Grout Used, Casing Type: <br /> []VVd|\nstx||aboo Well Destruction Blank—Feet Screen_' Slot Size: <br /> []Boring|nsta||ation []BohngDestruction Bags ofCement: <br /> METHOD USED Rags5and/Gravo|: <br /> Type/Brand of Bentonite: <br /> []Pressure6ro verDhU Filter Pack Type/S|ze: <br /> T�poof��ethod� <br /> naie []Other '--�� <br /> El Gravity ��.h�f re _____ <br /> 10/16/2017 <br />