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Groundwater Sampling Form <br /> Project Name (� (Ll S r Well No C{}- <br /> Project Number SQS - 1".'ell Type t.donrl,or ❑Extraction (]other•Recorded BySam le,J b <br /> P Y _ �/�� �P./l,d� Date S f <br /> WELL PURGING <br /> PURGEVOLUM,E s PURGE MI ETHOD <br /> Well casing diame[e 06ader-Type <br /> ❑ 2-inch 4-inch []Other Pr ump-T)'pe <br /> Well Total Depth(TD,It below TOC) ❑Ocher <br /> De 'h to Water YL ft below TOC .2• - to PUIJ,P INTAKE <br /> De th to free Phase hvdro:zrbons F?,ft below TOC h' r top Depth(ft) <br /> lot well volumes to be purged ear SoMom Dep'h(ft) <br /> U3 ❑ 10 ❑Other Other <br /> PURGE VOLUI.4E CaCULATION Pumping Rate cpm <br /> x 42L X = gaff <br /> WE'er Colx-m Lend h f."u sr;,er l,'o Vols CALCULATED FAJRCE VOLUIJE <br /> MULTIPLIER tCEslnoD.2 rindhesl=Gallonsrrnear c2' <br /> 2=0173=0�J 4=065 45=0E3 5=102 E= 15 E=A6, UAL PURGE VOLLVE <br /> GROUNDVJATER PARA'.'ETER f'EASUREI.'EldT Meler TypeTime!Gatlons ,4 Cond <br /> ldrty Color/Odor <br /> fuonhcs'cm L} <br /> -14 <br /> � 1 ' f ` � 1 L�yro ! •o i 1 b ! <br /> Commen's du*ing well purge <br /> VVe11 Pumped dy YE5NO Purge v iter s'g�;e'd'sposal []Drummed onsete 210,1her 1 L ay,�.cr9d <br /> h V` WELL SAMPLING <br /> Stiff IPL1NG WIETHOD Da:eri-imef Sa�nrred 17 Co <br /> Sa"er-Typed S a-,P;a port ❑ Other <br /> GROUNDVVATER SA14PLE PARAfeETER VEISUREMENTS I teter Type <br /> Da1el1 imel�necl a ce PH � Cond � ':erne deg C Tu�b,drly � Cob/Odor <br /> fuor ihcs/crn dea F MIT 111 <br /> 1 1 f <br /> SA1d,PL1NG PROGRAtA <br /> Sample No Conta ner Z/Vol t-e I Anahvs s Presen�'r�es Labora'o Com-nems <br /> I ►� ' 3c }- <br /> i <br /> f ! <br /> I <br /> QUALITY CONTROL S:.t'PLES <br /> DulaSamples <br /> Stank SamplesOngal Samle No. Du iczte Sample No T <br /> Sam le No <br /> Tn <br /> Rinsate <br /> Transfer <br /> Other <br /> P 1GVd1J.P1FORMS%TFx.QNS WK1 <br />