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Environmental ri 1 <br /> Leaving R Clean Envirdnment <br /> WELL DEVELOPMENTISAMPLING DOCUMENTATION FORM <br /> Protect Nam"ud' "' , l2_ t\&gj:Ecl� �1�tinC2- <br /> .fab# <br /> Date <br /> Sam lin earn Z� ' <br /> (Names/Responsibilities) <br /> Purpose of Sampling initial Verficatton Other ' <br /> Weather Conditions <br /> GROUNDWATER LEVELICASING VOLUME <br /> Depth Total Feet of Conversion Casing Volume <br /> Time TOC to GYV Depth, Wakes Factor Gallons <br /> Initial <br /> After develop/puMinn 14A,5an�7 <br /> At time of Sampling Z�. Three Casing Volumes G 4,S' Gals <br /> Ten Casing Volumes Gals <br /> WELL DEVELOPMENTIPURGING <br /> Equipment Swab-Aire Sub Pu p ailer Sandpiper Other <br /> Method Description <br /> Decontamination Method ` <br /> Water Contain rums baker tank other <br /> Labeled Ct <br /> Pump Vol Water T m EC Observations <br /> Ttme Rate Extracted F umhus H 1color turbid) oils odor <br /> Stasi L ¢_ <br /> 9S ro, <br /> ! t <br /> r � <br /> SAMPLE INFORMATION <br /> Lab <br /> Sampling Containers/Number of Containers/Analysis Preservation Description <br /> 1 Liter Ambe Ice and <br /> 40 mi Vo �-� � c, �� � Ice and ^ <br /> Other Ice and— <br /> Time <br /> Device Disposable Bailer✓ Other <br /> Pertinent Fieio Observations <br /> a <br /> Deviations frdn Standard Sampling Protocol <br />