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WATER SAMPLE FIELD DATA SHEET Rev. 5196 <br /> PROJECT NO: SAMPLE ID : <br /> PURGED BY: CLIF,NT NAME: <br /> O YY`►�.T SAMPI.I:D BY: LOC'A'TION <br /> TYPE: Groundwater Surface Water Leachate Other <br /> CASING DIAMETER(inches): 2 3 4 4.5 6 Other <br /> CASING ELEVATION(feeVMSL) : VOLUME IN CASING(gal.) : <br /> DEPTH OF WELL(feet) : CALCULATED PURGE(gal.) <br /> DEPTH OF WATER(feet) : ACTUAL PURGE VOL.(gal.): <br /> DATE PURGED: END PURGE: <br /> DATE SAMPLED: SAMPLING TIME: <br /> TIME VOLUME pH E.C. TEMPERATURE TURBIDITY TIME <br /> [(2400 HR) {gal.) (units) (µmhos/cmQ25°c) ff) (visual/NT J) (2400 HR) <br /> OTHER: ODOR: _ <br /> (COBAL7'0-100) (NTU 0-200) <br /> i FIELD QC SAMPLES COLLECTED AT THIS WELL(i.e_FB-1,XDUP-1): <br /> PURGING EQUIPMENT SAMPLING EQUIP ENT <br /> 2"Bladder Pump Bailer(Teflon) 2"Bladder Pump Bailer{Teflon} <br /> Centrifugal Pump Bailer(PVC) Bomb Sampler P Bailer(Stainless Steel} <br /> Submersible Pump Bailer(Stainless Steel) Dipper Submersible Pump <br /> Well Wizard"` Dedicated <br /> Wel] Wizard'" Dedicated <br /> Other: <br /> Other: <br /> WELL INTEGRITY: <br /> REMARKS: LOCK: <br /> pH,E.C.,Temp,Meter Calibration: Date: Time: Meter Serial No.: <br /> E.C. 1000 / _ _ pH 7 / PH 10 / PH 4 / <br /> Temperature°F <br /> SIGNATURE: REVIEWED BY: PAGE OF <br /> . FIGURE <br /> �JEMCON WATER SAMPLE FIELD DATA SHEET A-2 <br />