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WATER SAMPLE FIELD DATA SHEET <br /> PROJECT# I Cl(,Oo- bWELL I D <br /> O'{ -p 4 PURGED BY <br /> CL ,tr NAME 69-CO '2-133 SAMPLED BY.MLL SAMPLE 11) <br /> CATION. Lel D BErI } 0 G t QA SAMPLES <br /> DATE PURGED START(240011r) <br /> END(740011c) <br /> DATE SAMPLED -01 SAMPLE TIME(2400hr) <br /> SAMPLE TYPE Groundwater Surface Water Treatment Effluent Other <br /> CASING DIAMETER. 2' 3' 4' _ 5-- 6- 8' Other <br /> Casing Volume (gallons per toot) (0 I7) (0 383 <br /> (0 67) (L 02) (1 50) (2 6d) { ) <br /> DEPTH TO BOTTOM(feet) _ 9-A CASING VOLUME(gal) _ -rL.2- z _ <br /> DEPTH TO WATER{feet) <br /> r �p CALCULATED PURGE(gal) <br /> WATER COLUMN HEIGHT(feet) _ �" ACTUAL PURGE(gal) <br /> FIELD MEASUREMENTS <br /> DATE TIME VOLUME TEMP CONDUCTIVITY pH COLOR TURBIDITY <br /> (2400hr) (gai) (degrees I-) {um.��slcm� (units) (visual)s� <br /> L1L—L l � h S!2 <br /> rr „SAMPLE INFORMATION <br /> SAMPLE DEPTH TO WATER' 1� SAMPLE TURBIDITY l -- <br /> $OX RECHARGEV YES rNO ANALYSES 1 <br /> ODOR G SAMPLE VESSEL!PRESERVATIVE .�a A< z— <br /> PURGING EQUIPMENT _ SAMPLING EQUIPMENT <br /> Bladder Pump Bailer(Teflon) Bladder Pump Bailer(Teflon) <br /> Centrifugal Pump Bader(PVC) Centrifugal Pump X Bailer( _PVC or _dtsposabEe) <br /> Submersible Pump Bailer(Stainless Steel) Submersible Pump Bailer(Stainless Steel) <br /> Penstaltte Pump Dedicated Peristaltic Pump Dedicated <br /> Other Other <br /> Pump Depth rr <br /> WELL INTEGRITY LOCKlf "l - <br /> REMARKS <br /> • Page� of <br /> SIGNATURE <br />