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1 i <br /> GROUNDWATER SAMPLE COLLECTION DATA FORM <br /> SAMPLE I D NO.: o WELL NUMBER: <br /> DATE/TIME _._4- 3- 9 7 WEATHER: _(� s 140-ay <br /> ANALYSIS. z r d✓e <br /> WELL PURGING DATA. FILTEREDI Yes No <br /> Initial depth to water: 3 7 y Filter Device: Lu-line <br /> Depth of well: 2. 6, Filter barzW <br /> Volume of water in well: - Lab <br /> Date/time at start of purging- Other <br /> Method of purging: <br /> Method of Decontammaung <br /> purging equipment: <br /> �-oduc� 7� � p • <br /> WATER QUALITY OBSERVATIONS DURING PURGING: <br /> Volume Depth to <br /> Da purged water Temp. OF pH ECUdity, <br /> SAMPLE CONTAINER DATA. SAMPLE METHOD- <br /> Pum <br /> Number/type of container, gamer <br /> Other. <br /> VOA capacity: <br /> preserve: <br /> Amber capacity- <br /> preserve: <br /> Plastic capacity: <br /> prrser."e. <br /> Other (describe): <br /> SAMPLE PRESERVATION METHOD: <br /> Iced Other (describe): <br /> Signature: DateMme: <br /> 11�eerh t9�'1 <br />