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WATER SAMPLE FIELD DATA SHEET Rev. 1l9 <br /> PROJECT NO ; 792065 SAMPLE ID: <br /> PURGED BY : CLIENT NAME : USA N65 <br /> SAMPLED BY : LOCATION :.2250 West Lodi Avenue,Lodi <br /> ' TYPE: Groundwater 'r Surface Water Leachate Other <br /> CASING DIAMETER(inches): 2 3 4 4.5 6 Other <br /> ' CASING ELEVATION(feet/MSL): VOLUME IN CASING(gal.): 3,Q <br /> DEPTH OF WELL(feet):�?.3 CALCULATED PURGE(gal.) <br /> DEPTH TO WATER(feet): $ . T ACTUAL PURGE VOL.(gal.) : <br /> DATE PURGED : ,� jl G� END PURGE : Z3q <br /> DATE SAMPLED: SAMPLING TIME : <br /> TIME VOLUME pH E.C. TEMPERATURE COLOR TURBIDITY <br /> 11400 HR) (gal.) [u its) (pmhos/cm425°c) (°F) (visual) (visual) <br /> 1 -0 _ 7< <br /> OTHER: 11., ODOR: <br /> (COBALTd_i0o) 0-200) <br /> ' FIELD QC SAMPLES COLLECTED AT THIS WELL(i.e. FB-1,XDUP-1) <br /> PURGING EQUIPMENT ,SAMPLING FOUIPMF_.NT <br /> 2"Bladder Pump Bailer(Teflon) 2"Bladder Pump Bailer(Teflon) <br /> Centrifugal Pump Bailer(PVC) Bomb Sampler Bailer(Stainless Steel) <br /> 7—Submersible Pump Bailer(Stainless Steel) Dipper Submersible Pump <br /> i Well Wizard0 Dedicated Well Wizard6 Dedicated <br /> Other: Other: <br /> ' WELL INTEGRITY: Cy <br /> LOCK: Gy jCI <br /> REMARKS: <br /> pH.E.C.,Temp.Meter Calibration: Date: .5" A" Time: Meter Serial No.: <br /> ' E.C. 1000 1 pH 7 1 pH 10 ! pH 4 t <br /> Temperature°F <br /> ' SIGNATURE: REVIEWED BY PAGE OF <br />