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Harding Lawson Associat GROUND-v rER SAMPLING FORM <br /> Engineering and _ <br /> Envircnmenta Services Well No <br /> q�b e � /" Well Type onitor :1 Extraction 0 Other <br /> l/C7� Well Material C 0 St Steel ❑ Other <br /> ob Number Z Z Date Time Zff- <br />' Recorded by r Sampled by <br /> ISgnaN / ilmnalsl <br /> PURGE ©LUNE u'�'I�RE NCE H._QO. <br /> OL .i .>a <br /> Cas Diameter(D in inches) 7 Bad Type <br /> inch ❑4-inch ❑6-inch ❑Other ubmersible ❑Centrifugal ❑ Bladder Pump No <br />' Total Depth of Casing (TD in feet BTOC) ❑Other Type <br /> Water Level Depth (WL in feet BTOC) "per INTAKE$�NG'I <br /> Numpe of Well Volumes to be purged(#Vols) <br /> ear Bottom 0 Near Top ❑Other <br /> ❑4 ❑5 ❑ 10 ❑Other <br />' Depth in feet(BTOC) Screen Interval in Feet(BTOC) <br /> Rq1 YQL.UME G�L�l1LATiTQ from to <br /> XX _ X 0 0408 = 7 gallons <br /> TD (feet) WL(feet) D (inches) #Vols Calculated Purge Volume <br /> 'R51FERPOKU <br /> f Start/ Stop_ Elapsed Initialgpm Final 7L_ gpm $ gallons <br /> Mrr+ates Since H Cond T� Other Minutes Since pH Cond m} T O of Other <br /> Pumping Began p (µmhos/cm) Pumping Began (µ <br /> Z 21.0. <br /> D <br /> IMF 70-e r_ 7=9 I <br /> 70 ZZ6 Meter Nos <br /> Observations During Purging (Well Condition,Turbidity Color, <br /> Discharge Water Disposal ❑ Sanitary Sewer ❑ Storm Sewerthey r� <br /> ❑ Same As Above <br /> oiler-Type / f ❑ Grab-Type <br /> D Submersible ❑ Centrifugal ❑ Bladder, Pump No ❑ Other-Type <br /> Sample Series <br /> Sample No Volume/Cont Analysis Requested PresqryaSEes L Comments <br /> Duplicate Samples Blank Samples Other Samples <br /> Original Sample No Duplicate Sample No Type Sample No Type Sample No <br /> ' RL004 OFMC11Caw W.TE F*uo Cow C— 0746 <br />