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Groundwater Sampling Form <br /> 01,iject Name 1 f-),A Lv C 0 A Well No <br /> Project Number o 4 o Well Type (�Monrtor ❑Extraction (]Other <br /> Recorded By f Sampled by S' Date <br /> WELL PURGING <br /> PURGE VOLUME PURGE METHOD <br /> Weil casing diameter Bailer-Type <br /> ❑ 24nch 4-inch []Other 3 Q G3 Pump-Type , — <br /> Well Total Depth(TD,R below TOC) 5"O a ❑Other <br /> Depth to Water ft below TOC PUMP INTAKE <br /> De th to free phase h rocarbans FP ft below TOCI Near top Depth(R) <br /> ii Number of well volumes to be purr <br /> 0 I�►vther Other <br /> E] 3 11 1 <br /> PURGE VOLUME CALCULATION Pumping Rate _ S gpm <br /> —_11 3`� x 66 x _ -?o n <br /> Water Column Length MulLprier No Vols CALCULATED PURGE VOLUME <br /> MULTIPLIER(Casinq Dia inches =GallonsJTnear R qal <br /> 2=0173=038 4=066 45-063 5= 102 6=15 8=26 ACTUAL_ PURGE VOLUME <br /> GROUNDWATER PARAMETER MEASUREMENT Meter Type S_u1+,,,CT <br /> Tiime/Gallons =P11 <br /> Cond Temp EdFa! <br /> g C Turbidity Color/Odor <br /> uomhos/cm eg: NTU <br /> s / I v- u <br /> 31 / ' 10 7 f r h y 3 13- / U e9" <br /> 1i / s 1.4 I-ti t)s 1 L114,W F <br /> 13g / — ar os 3 -15-q< r <br /> [ b a 1 r l Lf 3 r OFF <br /> 1 <br /> r <br /> Continents during well pur <br /> Well Pumped drjr YES D Purge water storage disposal ❑Drummed onsite Nother <br /> WELL SAMPLING <br /> SAMPLING METHOD DatelTune Sampled �Lol III p <br /> Bailer-Type N LM= Sample port ❑ Other [1 <br /> GROUNDWATER SAMPLE PARAMETER MEASUREMENTS Meter Type___.) S) <br /> Date/Trmet%Recharge pH Cond Temp eg C Turbidity Color/Odor <br /> uomhos/cm [Ideq F NTU <br /> /4 / / 7 O /re-1- /. x- <br /> SAMPLING PROGRAM <br /> i <br /> Sample No lContarnerglVolume Anal rs Preser+ratrves Laborato Comments <br /> Tic 5-7",— Y CA <br /> I <br /> QUALITY CONTROL.SAMPLES 3 <br /> Duplicate Samples Blank Samoles I <br /> Onainal Sample No Duplicate Sample No T Sample No <br /> l <br /> li <br /> Trip <br /> Rinsate 4I <br /> Transfer <br /> Other <br /> r <br /> I <br />