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QUARTERLY GROUNDWATER SAMPLING FORM <br />CLIENT 51 CM -1) L <br />SITE <br />DATE I l S <br />WELL NUMBER <br />SAMPLER SIGNATURE <br />WELL DESCRIP'T'ION: <br />v v <br />Casing Dia ter W 4 16 / 8' <br />Locked (Y)/ N KEY NO 3 dy <br />Casing �nta/ Damaged <br />Concrete Sea ntac / Damaged <br />WATER COLUMN DESCRIPTION: <br />Floating Layer Y N Thickness (in } Sampled. Y /0 HNU/OVM Reading in well: <br />Depth to well bottom <br />(4) <br />Depth to water surface (avg) <br />Standing Water Column <br />Well Diameter Factor <br />�,� (2" 0 17, 4. 0 65, 6' 1 47, 8' 2.61) <br />One Well Volume <br />�• <br />Volumes to be removed <br />Gallons to be removed <br />�• �� <br />PURGE MEASUREMENTS-.'yixv <br />Purge Device <br />Purge Rate (gpm) <br />Turbid <br />Volume Temp <br />Sp Cond Odor <br />YIN <br />Time (gal) °C <br />pH (uMhos) YIN Alkalinity <br />Color HNu/OVM <br />11157 t <br />6, 4 -700 Aj <br />%a 27 <br />7.0 (V Olo A3 <br />111-3 t2 27 <br />7, 1 -_ G 7o A) <br />cI <br />SAMPLINGIANALYTICAL INFORMATION: <br />Sampling Methodade I Pump / Other <br />Dedicated Y /0 - <br />Sample Number <br />Sample Time It 3o <br />Dup4cate G�? N Duplicate <br />Sample Number - <br />Sampling Parameters <br />Holding <br />Analyte Method <br />Container Volume # Bottles Preservative Time <br />EEL <br />NOTES: <br />"a <br />SrKVti'TMM£COR WP <br />ovie 4 <br />