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' GROUNDWATER SAMPLING FORM <br /> Project Name Well No <br /> ' Project Number Well Type IlMomtor OExtraction FLOther <br /> Recorded By Sampled by Date <br /> welly PUR41N <br /> ' P�R���fOE,E)y!>~ PUR��hE$TIiOD <br /> Well casing diameter ❑Bailer 1 Type <br /> 2-inch ❑ 4-inch Other Opurnp 1 Type <br /> ' Well Total Depth(TD ft below TOC) Other <br /> Depth to Water(WL,ft below TOC) PUMP INTAKE <br /> Depth to free phase hydrocarbons(FP ft below TOC) Near top Depth(ft) <br /> Number of casinItu e <br /> volumes to be pd Near Bottom Depth(ft) <br /> LJ' 3 10 Other Other <br /> PlJRGV V0E, MV4 MMI-ATION <br /> X X gals <br /> ' Water Column Length Multiplier No Vols CALCULATED PURGE VOLUME <br /> Total Purge Time (Multiplier 3/4"=007.2"=017,4"=066) gals <br /> Recharge Rate Purge Rate ACTUAL PURGE VOLUME <br /> 0ROtNQWAT111PAE3AMITERM URENfENTS Mete,Type <br /> Time 1 Gallons pH Cond Temp deg C Turbidity Color 1 Odor <br /> mmhoslcm deg F NTU Remarks <br /> 1 <br /> r <br /> r <br /> 1 <br /> 1 <br /> 1 <br /> 1 <br /> r <br /> Comments during well purge <br /> Purge water storage/disposal Drummed onsite n Other <br /> —WC--LL SAMPLING <br /> ' SAMPLINGMRTHW Dater rime Sampled <br /> Bailer-Type ❑ Sample port Other n <br /> (�ROL)NDNVAT414 SAMP4E VAS;4AM�TE V4A5QRE:jilE1~W$ Meter Type <br /> Date 1 Time!%Recharge pH Cond Temp deg C Turbidity Color!Odor <br /> ' mmhoslcm Hdeg F NTU Remarks <br /> JAN1P41 NG FROGRAM <br /> ' Sample No Icontainer#Noiume Analysis I Preservatives I Laboratory Comments <br /> ' WAU11Y CONTROL SAMPLE$ <br /> Duplicate Samples Blank Samples <br /> Original Sample No Duplicate Sample No T Sample No <br /> ' <br /> Trip <br /> Ri <br /> Rinsate <br /> Transfer <br /> Enwronmentaart! d Geotechnical Consultant Other <br /> Ll1 <br /> 1 <br />