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GROUNDWATER SAMPLE COLLECTION DATA FORM <br /> SAMPLE I D. NO.: a) - 1,4 WELL NUMBER. / A <br /> DATEITIME y-3-12 12:/_S_ WEATHER. C 1•s s_ __ Gr/.-+,,., <br /> ANALYSIS. �77-Y6 op 011C 4- =14-Ani t') - 7rrsr,� &/O <br /> WELL PURGING DATA: FILTERED? Yes a <br /> Initial depth to water: y. 73 Filter Device: In-line <br /> Depth of well. )T, 2 Filter barrel <br /> Volume of water in well: 1, Lab <br /> Date/time at start of purging: Otber <br /> Method of purging: Tq,1 et- <br /> Method of Decontaminating <br /> purging egiupment: <br /> WATER QUALITY OBSERVATIONS DURING PURGING: <br /> Volume Depth to <br /> Date/time purged water Temp. OF pH EC Umhos <br /> l572 62A0 173 2 23 ` <br /> 02,179 1 � <br /> 1? Ob r r <br /> SAMPLE CONTAINER DATA: SAMPLE METHOD: <br /> Numberltype of container. a1ei <br /> er. <br /> VOA capacity: 140 14, <br /> preserve: _ _ 14L41 y AXW <br /> Amber capacity: -_.1�n tw <br /> preserve: � <br /> Plastic capacity: r,r <br /> preserve: 4jQ O ,- <br /> Other (describe): <br /> SAMPLE PRESERVA N METHOD: <br /> _)L Iced Other (describe): <br /> Signature: DateMme. 41-3-9'7- 1 Z' i <br /> PM+rt 1051 Much 1591, <br />