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ACTON - MIC'KEISON -van DAM, INC <br /> SAMPLING/DEVELOPMENT INFORMATION <br /> Sampliug/Deveiopment Point Project /FeDf CS <br /> Location &92242/t/ `1~Y' Work Order # <br /> Sample I.D. Date Sampled/Developed_ <br /> Describe Sampling/Development Point Time - AM/PM <br /> Well Depth *3 feet below MP Casing Diameter inches <br /> Depth to Water (below MP) 73. /9 feet Date o - ?C- S' Time q AM/PM <br /> Discharge Rate gpm <br /> At least 3 bore volumes have been evacuated before sampling. <br /> Sampling/Development Method: <br /> Tap--x - Submersible - Bailer Centrifugal Pump <br /> Other <br /> Pump intake or bailer set at feet below MP. <br /> Sample Appearance: Odor: <br /> Note any Sampling Problems: <br /> Note any Cleaning or Effort to Reduce Possible Crass-Contamination: h ; .o.�,- �,- <br /> ampler Collected: 3 4ev 21J. <br /> EVACUATION/STABU-IZATION'IEST DATA <br /> Temperature -Cumulative <br /> Corrected Volume of Water Pumping <br /> PH Conductance Temperature Water Level Removed from Well Rate <br /> Time (units) (umhos/cm) (°C) (nearest 0.01 foot) (gallons) (gpm) <br /> y.SU <br /> 160 7/. F i z <br /> /2=0 22, <br /> Bailing Start Time �/3"`� yam, <br /> Bailing Stop Time /.may WL <br /> mments: <br /> Form Completed By: � � Witnessed By: <br />