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Harding Lawson Assoclat GROUND-► TER SAMPLING FORM <br /> _ Engineering and <br /> Environmental Services Weil No <br /> Job Name Well Type �1Gfoni or ❑ Extraction ❑Other <br /> Well Material oTPVC ❑St Steel ❑ Other <br /> Jab NumberT�7��1Z— - Date — Time /2 L� <br />' Recorded by� �_ _ _ Sampled by <br /> (Sgrafurel !lmnarsl <br /> LL-PURGI!\V7 <br /> 6PURGEUU 1) <br /> Cas Diameter(D in inches) ❑ Type <br /> inch 0 4-such o 6 inch 0 Other ubmersible ❑Centrifugal ❑ Bladder Pump No <br /> 0'2-' Total Depth of Casing (TD in feet BTOC) ❑Other-Type <br /> Water Level Depth (WL in feet BTOC) �� P W >NG <br /> Number of Well Volumes to be purged (#Vols) <br /> O 3 <br /> ❑4 r0 5 ❑ 10 0 Other ear Bottom 0 Near Top ❑Other <br />' Depth in feet(STOC) Screen Interval in Feet(STOC) <br /> PURGE�t # �M "CGtLA from to <br /> 3 2 <br /> 1 x X _�T _ X 0 040$ = gallons <br /> TD� WL(feet) I D (inches) #Vols Calculated Purge Volume <br /> Stag .'-Stop_ Elapsed Initial gpm Final 2— gpm — — gallons <br /> a <br /> ftnwws <br /> Since H Cond T❑°C Other Minutes Since pH hosCond/cm T q'F Other <br /> Pumping Began p (gmhos/cm) Pumping Began (g ) <br /> Ew C> <br /> Meter Nos <br /> Observations During Purging {Well Condition, Turbidity Coior Odor) �� <br /> Discharge Water Disposal to Sanitary Sewer ❑ Storm Sewer er <br /> MEN Q0 9—M 0 Same As Above <br /> ❑ Bader-Type ❑ Grab-Type <br /> ' 0 Submersible O Centrifugal ❑ Bladder,Pump No O Other-Type <br /> Sample Series <br /> ' Sample No Volume/Cont Analysis Requested Preservatives Lab Comments <br /> 1 <br /> 1 <br /> ' Duplicate Samples Blank Samples Other Samples <br /> Original Sample No Duplicate Sample No Type Sample No Type Sample No <br /> ' AL004 OwmaCan Ware FwaaCorr C—ma 0746 <br />