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i <br /> Purize Loi Form <br /> %toject Name '�"'�'' Project Nunber Site Location J wcx, <br /> Well No Date Cil lu4to Field Tech 4-f <br /> Total Derth S �. Depth to water 3 �' �� Water Colum Lengul, j • Q 8ry <br /> Casing Duune:er Casino Facto .1 Volumc Calculavon 3- <br /> ' Total Parge Volume Casing volurres Frocucea LI-9 P"ttna Ty-,,C 'S a <br /> PH M-.-c:- Cshbrated �I)or N Cond NIve- Calibrated 0)or I+ <br /> Temp Itileler Turoid* Meer / Caltoitcd Y or N <br /> I ' {Casang Factor 3"= 17 3"=38 4"= 66 5"=1 02 6"=1 5 V=2 6 On Gallons pe-It m:r faot)] <br /> ' T,m-- -Prod Acte Gallons total) D T W Ph Ec Te—,:) (IC) Tumidity Ccr•.t.-ne 71 Ls <br /> X I ?y I b T'-� 1 1377 i -)3,�A I AA I Lr dA v,,:A Azi�, <br /> yt a 14.60 I /393- 6& wt, I <br /> -ss 1 o R uPF <br /> �.�.� I � /S. L, I �1•w� I (a.rs � f39p ! 3-� I � � <br /> ! I I I I I I I <br /> ' Swrzac or Disposal M.thad �r Total Drums Orsuc <br /> ' Pc�cint Rr_:targ:Pratte Sampling ) Ott Sa-rplc Collecticn Method <br /> Sample Labeled � MU, ' Sam Ic Time 3 s Laboratar. C <br /> ' Analyse; 13T-CA I'TPA i 8j.60 <br /> No c+fContainers <br /> Duplicate Tnp Blank Rinmte Blank <br /> ' CCnitrten <br /> is <br />