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IPuroe Loan Form <br /> ect Name Protect Number b Site Location sc/ , <br /> CI <br /> No �— Date 0 6 7 iY 1-e1 Field Tech . 14 <br /> otal Depth Depth to water �`� Length �+'f. 4 <br /> p Water Column <br /> lasing <br /> Diameter Z. Casing Factor , 17 Volume Calculation 'a ,14 <br /> Total Purge Volume 0 Casing volumes Produced 3 F Pump Type ,64,4& <br /> Meter 04k�ok_, Calibrated o'or N Cond Meter 0ak,Gr- <br /> Calibrated Y or N <br /> Imp Meter Turbidity Meter AA _ Calibrated Y or N <br />[Casing Factor, 2"= 17 3"=38 4"=66 5"=142 6"=1 5 8"=2 6 an Gallons per Iinear foot)] <br /> 1 <br /> e==prod Rate Gallons(otal)=DTWTem [°C)-Turaidtty- Coriiments= --- _ <br /> Oqq <br /> 30 + -s' 6.� _?�.0 1 /rSN n. t <br /> 12 <br /> y Y- <br />�ge or Disposal Method_ �,f Total Drums Onsite <br /> rcent Recharge Prior to Sampling Old Sample Collection Method e <br />'ple Labeled —7—ln/ Sample Time Laboratory_ <br /> Salvsls Oku T. L, fob _�Z moi• c c& No of Containers S <br /> licate Tnp Blank Mnsate Blank <br /> Iments <br /> 1 <br />