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�z <br /> _ <br /> ' SAXIPLING INFORMATION SHEET Ocie <br /> ion <br /> Envirunrnentat <br /> SujtantS, <br /> Inc: <br /> Sate le IDS Project Name. <br /> e50�CO 1?roject No_-bms <br /> 4Oca600 (address) 2ggg Wes ye <br /> .bam Sampled: Time: <br /> 'Vsf assembly condition: X Good FairPoor(If poor, seecomments) <br /> Equi*nent Replaced: bolts locks locking cap j <br /> Wein tlx ��1, l : <br /> ft below top of easing Casing diameter 2 inches <br /> pttl`to'water(below top of casing) fLDate: Z 1 16 I Time <br /> "?4VCIP�asin9 Volume Multiplier: 0.16 for 2", 0.65 for 4", 1.47 for 6" <br /> 'gstt g method: Submersible pump )d Bailer Ccatrif tgal PumP Other <br /> 'At least well volumes have been evacuated before sampling. <br /> I <br /> Tubi6g(type; <br /> (new or previously used) was used to purge well <br /> Sampling method: }o Disposable bailer Sampling part . <br /> Samples collected Sample appearance <br /> I <br /> Note any sampling problems <br /> I <br /> GROUND WATER EVACUATIONISFAB=ATION DATA <br /> Cumulative Volume of <br /> Conductance Water Level Water Removed from Well <br /> Time - I'em{=tum ("F pH Units (umnos/cm) (Nearest 0.01 ft) (ga(lons) <br /> 70 <br /> 17,!d!; z 1 Z v.S`1 ::j <br /> i <br /> Corn eats-, <br /> TOMSPQUtioa(fherWA preservation) <br /> Form completed by: Sampled by: <br /> i <br />