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�-�- Harding Lawson Associat GROUND- �- TER SAMPLING FORM <br /> Engineering and <br /> Environmental Services Well No _ <br /> Well Type *} Onitor ❑ Extraction Z)Other <br /> Job Name Well Material C ❑St Steel ❑ Other <br /> Job Number Date — Time /Jef/� <br /> Recorded bySampled by <br /> ~�Signarurel (ln,haetl <br /> r �� <br /> WEEt PURGtNC.��.�'N a v _ I y <br /> hPURGEV01 ME `PURGE ME�-I00,' <br /> Casi iameter(D in inches) ❑Toder Type <br /> inch ❑4 inch ❑6-inch ❑Other �Submersible ❑Centrifugal 0 Bladder Pump No <br />' Total Depth of Casing (TD in feet BTOC) ❑Other-Type <br /> Water Level Depth (WL in feet STOC) Co 9m@ <br /> Num r of Well Volumes to be purged (#Vols) UMP-IN �ltKE'.SIO <br /> ❑4 ❑5 ❑ 10 ❑Other ear Bottom Q Near Top ❑Other <br /> Depth in feet(BTOC) Screen Interval in Feet(BTOC) <br /> PARRGEIV(:TL_6ME,C U tQU t N from to <br /> 9-/12 X Z._ X CT X 0 0408 gallons <br /> TD (feet)W r WL(feet) D (Inches) #Vols Calculated Purge Volume <br /> EI ITE � O � �1RG IEr <br /> tAA � � _ _ <br /> ' ,yv Start Stop Elapsed Initial Z gpm Final gpm 9 gallons <br /> IDA <br /> Since pH Cond T Q�° Other Minutes Since pH Cond T❑oC Other <br /> Pumping Began (µmhos/cm) F Pumping Began (µmhoslcm) ❑ F <br /> !4 72>1 016Zf <br /> Meter Nos <br /> ' Observations Dunng Purging (Well Condition,Turbidity, Color Odor) <br /> Discharge Water Disposal Q Sanitary Sewer ❑ Storm Sewer ther d <br /> a <br /> ❑ Same As Above <br /> ailer-Type ❑ Grab-Type <br /> t ❑ Submersible ❑ Centnfugal ❑ Bladder,Pump No ❑ Other-Type <br /> Sample Series <br /> ' pie No Volume/Cont Analysis Requested Pr servatives ObComments <br /> AOZ <br /> 1 <br /> Duplicate Samples Blank Samples Other Samples <br /> Original Sample No Duplicate Sample No Type Sample No Type Sample No <br /> ' RL004 Orrice Gori W.nre FWx Con Guam 0746 <br />