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Groundwater Sampling Form <br /> Site Name of Number: <br /> Project Number: <br /> a n to i.aa Location (City,State) <br /> group <br /> Date: <br /> (If found, please call 1-800-477-4711) Page: of <br /> Well ID: <br /> Sample ID: <br /> Traffic control set up at well (start time): <br /> Casing volume (gal): <br /> Purged by disposable bailer(Y/N)? other: <br /> Measured in 5 gal pail? other: <br /> Purge time (from): <br /> Flow Rate (gal/min): <br /> Depth to water T(deg C) pH Cond (mS/cm) DO (mg/L) ORP TDS <br /> Start purge time: <br /> Volume purge (gal): <br /> Purged dry(Y/N)?: 80%water leve Initial DTW <br /> Pre-sampling depth to water(ft): <br /> Sampled by disposable bailer(Y/N): other: <br /> Time/date sample: <br /> Sample container type No. of containers Preserved by At what pH Filter type <br /> No. of containers: <br /> Sample color/clarity: <br /> Duplicate sample number: <br /> Time collected: <br /> Samples cooled by ice (Y/N)? <br /> Any conditions affecting sample quality(Y/N?) <br /> Purge water disposal: <br /> Well cover secured (time): <br /> Traffic control removed (end time): <br /> Sampled by: Reviewed by: <br />