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f Groundwater Sampling Form <br /> Project Name r �l�C o S�p�ICTo� Well No / o <br /> Project Number i 13 0 `i o a Well Type f®Mondor ❑Ljdract,on []Other <br /> Recorded BY f cam Sampled b A r <br /> P Y Date G 9 a x g%( <br /> WELL PURGING <br /> PURGE VOLUME PURGE METHOD <br /> Well casing diameter Bader-Type <br /> ❑ 2-+nch IT 4-4nch ❑Other y <br /> LJ pump-Type <br /> Well Total Depth(TD,R below TOC) Lf 2 T []Other <br /> Depth to Water 4.ft below TOC Ljo 71 PUMP INTAKE <br /> De th to free Phase hydrocarbons FP ft below TOC Near tap Depth(ft) <br /> Number o well volumes to be pui ed ear Bottom Depth(ft <br /> ) H u <br /> ❑ 3 ❑ 10 Other y Other <br /> PURGE VOLUME CALCULATION Pumping Rate <br /> 11 X 6 X I-/ = v aE <br /> Water Column Length Muthplier No Vols CALCULATED PURGE VOLUME <br /> MULTIPLIER(Casing Dra inches =Gallonsllinear tt a O u �al <br /> 2=0173=0313 4=066_[45=08315=10216=1518=26 ACTUAL PURGE VOLUME <br /> GROUNDWATER PARAMETER MEASUREMENT Meter Type Y r) <br /> Time/Gallons pH Cond Temp deg C Turtiiddy Color/Odor <br /> uomhos/cm d F NTU ljJT4✓ <br /> las ! H rj u `I s 0 u' e2A, <br /> y 1 0,*- <br /> z <br /> air , ta Na <br /> l r y 1 u s-cj r e ? 1 <br /> / <br /> Comments during well purge <br /> Well Pumped dry- YES NO Purge water storageldisposal Drummed onsite QJMer 1AA-,6K at /( j{ti I <br /> `WELL SAMPLING <br /> SAMPLING METHOD Datefrime Sampled ;)-.114 <br /> Bailer-Type /S2brAW- - _ Sample port Other rT-- _ <br /> 13ROUNDWATER SAMPLE PARAMETER MEASUREMENTS Meter Type <br /> Datelfimet%Recharge pHCond Temp deg C Turbidity Color/Odor <br /> uomhos/cm d F NT11 <br /> SAMPLING PROGRAM <br /> Sample No Container XNolurne Anal is Preservatnres Laborat Comments <br /> -e- 0 _r77-0�kTa­' JML t L <br /> QUALITY CONTROL SAMPLES <br /> Du Gcate Sam fes Blank Samples <br /> On anal Sam le No Du Grate Sam le No T-Y PS Sample No <br /> Tn S ,h,J 7jp <br /> Rinsate <br /> Transfer <br /> Other <br /> P 1GWMPIFORMSITFX-OMS WK1 <br />