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S AMPLER <br />ADDRESS <br />CITY <br />WELL SAMPLING FIELD DATA Sr-iEET <br />DATE <br />JOB n <br />SSS <br />Well 1D /v W_ <br />Well Locaticn Description <br />f1 <br />Well Diameter In <br />Total Depth ft <br />Depth to Liquid ft <br />of casing <br />Volume <br />Purge Equipment :57 al, k <br />Did well dewater <br />Well Condition <br />c 0 <br />Hydrocarbon Thickness <br />Volume 2' = O 17 6" = 1 5o 12" = 5 so <br />Factor 3- = O 38 <br />{VF} A' = O 66 <br />X(VF) i nI=5tlmated <br />gal. <br />purge <br />f'� /� Volume <br />—Sampling EquipmentY /24ai r� <br />If yes, Tirne <br />Volume <br />Starr:;ng Time e 3_�) Purging Flow Rate <br />Sampling Time <br />L/ 9Qm_ <br />T"Ime <br />C;3C-1 <br />H <br />Conductivity <br />I� <br />Ll 3 ► <br />Il 3 Z <br />Ternper-ture <br />22- <br />-z C -9, <br />-7 <br />Weather <br />Weather Conditions ylr���� �{ G✓ a,,,i " <br />Water Calor f Odor <br />Sedirnenr Description v� <br />LABORATORY INFORMATION <br />Samole IO <br />5 <br />Volume <br />�.amments <br />