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Groundwater Sampling Form <br /> Project lr'am o y) [3;b.2TE1Z V3Y s's>�[k`Cd3 VJell No MW- 3 <br />�[ojectNumber p t —*Zr Well Type []Rtondor E]Exiractrom Other <br /> Recorded 6y Sample--,1`y $$ Date !— —q 5 <br /> s <br /> WELL PURGING <br /> PURGE VOLUh1E PURGE METHOD <br /> Welf casing dameter (]Euler-Type <br /> 2-inch ® 4- ch []Other SPvmp-Type a e,G. SU6. <br /> Well Total Dep'h(TD,ft beloeiTOC) 5,0 `t Other <br /> De th to W2ier 11YL n t—low TOC 9�•i , , PUMP INTAKE <br /> Denth to free `ase hvdrucarbons FP ft be ow TOC Near lop Dep.h tf) <br /> Number o well volumes to be pureed Near 5o lora Depth(f) <br /> © g � 10 Other <br /> Other <br /> PURG�VOLU1:E CALCULATION � Pump ng R2to 1O cpm <br /> i g, x o46 / x �`� <br /> V+'z'er Colu,�,n Len,ti 11J`ip',er No Vo's CALCULATED PURGE VOLUIJ,E <br /> lAULTJPLIER Casrna Dia i rches =G21lons1knear;1 1 2 Cal <br /> 2=0113=058 14=065 145=083 5= 102 E = 1 S,5 =25 f ACTUAL FURGE VOLUME <br /> GROUNMYATER PAPAT'ETER ItEASURFMENT t',eter T vpe MYROV) LgDS <br /> Tm,e/Czllars I p'� Cond I Te—,pI <br /> 1u"hcs deg C Turt)ic:ty Color/Odor <br /> —1 x deo F I h'T U1 <br /> I '7 O C7 G ' D. <br /> oo 1 7 . & ! ICb <br /> �0 r to ! '-,Gi l a nv I I r? v l <br /> r I I I I ! <br /> � I I I I i <br /> r I I I I I <br /> Co—iments dinng well p-ce <br /> V.ell Purnpedd'y YES :O Purge H.'e, s'c.3edsasat ❑DrJm—,edc^ste Other Qj <br /> I WELL S,^VITLING j <br /> SAI YLING f 4ETHOD Calef—ii^ue Sampled S—IS` 95 1 S <br /> Sz—p'e pot ❑ Other n <br /> Eater-Type <br /> GROUNDWATER SAVPLE PARAWETER 1.'EASUREI BENTS L'e'er T)?e <br /> Dat �+er5u Fec`a'�e P4Cond I Te'ap deg C I Tv�brd'y CotorlOdor <br /> vos�hes+c-n deo F k NTU <br /> SAId,�L1NG PROGRI,l�t <br /> s2-nnle No Container VNolume Ara'+s s 1 Frese�+c'Nes Lzbc,Vo Commen's <br /> — 140A a k sSom—Seto I leu. <br /> I v0A s I c.ol I 11a� j <br /> I I I I k <br /> QUALITY CONTROL SAMPLES,,,, <br /> Du 1kzte Samples Blank Samples <br /> Onainal Sample No Du lisaie Sam le Na T Sam le No <br /> Tn <br /> Rrnsale <br /> Transfer I <br /> Other <br />