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SAMPLING wF4RMA1 oN saEET <br /> Envirmirnentait <br /> / Consultants,to <br /> Satuple ID# � Project Name: ��'"`�' Project No. �c <br /> 40eauioa (address) <br /> ` .bam S led: 1 f f7S Tome - <br /> . !VY�{!h assembly condition: Good Fair _ __-- Poor (ff poor, Ser comments) <br /> I✓qu►�},Qi nt Replacrc�: bo is tacks locking cap <br /> Weft tlt �S�J• {o� ft below top of a sing Casing diameter inch <br /> water low top of Casi '' �. fL Dare:5/ / o S ',are <br /> ;'VITe<ll' 'acing Volume &f ddplier: 0.16 for 2", 0.65 for.4", L47 for 6" <br /> 'Phutgusg me thud: Submersible pump _ Bader Centrifugal pump <br /> Other <br /> . -At least � }} well volumes have been evacuated before sampling. <br /> TubWg (type: - J. (new or previously used) was used to purge well <br /> Sampling method: Disposable bailer _Sampling port <br /> Samples collected _-- Sample appearance <br /> Note any sampling problems <br /> GROUND WATER EVACUATfONISTABnJZATION DATA <br /> C muladve Volume of <br /> Condoerance Water Level Water Removed fiam W <br /> T'uuc Tempmatum ("F) pEfUnits (um WCM) (Nest 0.01 R) (gallons) <br /> 'ro-x 3 <br /> eIkJj 6r�l�L. W73 5 <br /> �-a,,�y <br /> comInwtsr <br /> r�nsgocC¢tioa ithetzual pmServation) <br /> Fossa compieted by: . - _, _ Sampled by: <br />