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Harding Lawson Associa% GROUND-1 TER SAMPLING FORM <br /> Engineering and <br /> Environmental Services Well No <br /> Job Name lG Well Type 3�IGfonitor ❑ Extraction :1 Other <br /> Well Material �j St Steel ❑ Other <br /> *Job Number Z Date Time <br />' Recorded by Sampled byQ <br /> ($gnarwel fln+fafsl <br /> e 1a dsy�,� v �: a� ,-��*s-�� n iy�t„7 rs>,f m,�� � -�,.�xY�+ <br /> U GN <br /> PURGE�IOLURft '`EUjKGE STH <br /> a.,..U.R <br /> Cann iometer{D m inches) ❑Sai r-Type <br /> inch ❑4-inch ❑ 6-inch 0 Other 3rSubmersible ❑Centrifugal Cl Bladder Pump No <br />' Total Depth of Casing (TD in feet BTOC) ❑Other-Type <br /> Water Level Depth (WL in feet BTOC) U LAK <br /> Num r of Well Volumes to be purged (#Vols) Near Mp:;rBottom ❑ Ner T Top J Other <br /> ❑4 ❑5 ❑ 10 ❑Other <br /> Depth in feet(BTOC) Screen Interval in Feet (BTOC) <br /> PsURGE� Q. fME€�lll IAS from to <br /> L1 <br /> 2 <br /> X - X X 0 040$ = 7 Z gallons <br /> ' TD (feet) WL(feet) D (inches) #Vols Calculated Purge Volume <br /> Stary� Stop !:P' Elapsed Initial Z— gpm Final Z gpm T3 -- gallons <br /> Since pH Cond T❑_'rV Other minutes Since pH Cond T❑oC Other <br /> Pumping Began (µmhos/cm) tater Pumping Began (µmhos/cm) ❑ F <br /> Meter Nos <br /> Observations During Purging (Well Condition,Turbidity, Color Odor) �Y! <br /> Discharge Water Disposal ❑ Sanitary Sewer ❑ Storm Sewer or !v1- <br /> ti <br /> ❑ Same As Above <br /> r8a,MlerType =ej& ❑ Grab-Type <br /> ❑ Submersible ❑ Centrifugal ❑ Bladder,Pump No ❑ Other-Type <br /> Sample Series <br /> ' Sample No Volume/Cont Analysis Requested Preservatives Lab Comments <br /> zww <br /> o �'Zlau� <br /> Duplicate Samples Blank Samples Other Samples <br /> Original Sample No Duplicate Sample No Type Sample No Type Sample No <br /> RL004 Opme Co.+ W-Te pots Co Cir 0746 <br />