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ACTON • MICI ELSON • van DAM, INC. <br /> SAMPL LING/DEVELOPMENT INFORMATION <br /> Protect Name L4°S'-1 <br /> 5ampltng/Development PointT 'r_nYa-3 - <br /> Sample I D Project No 1 005 .o"N <br /> Descnbe Sampling/Development Point Work Orde # <br /> Date - 1 1 1 1 L[Sy - -- <br /> FieId Crew ?-, - <br /> i1 <br /> WeU Depth a 3 feet below QIP Casing Diameter y inches <br /> Depth to Water (below MP) feet <br /> Discharge Rate gpm Time A.WL PM <br /> Number of borehole volumes <br /> evacuated before sampling > 3 <br /> Sampling/Development Method <br /> Tap Bailer Centrifugal Pump <br /> �^ Submersible Other <br /> Pump intake or bailer set at feet below -'vfP <br /> Sample Appearance fL. <br /> Note any Sampling Problems _Wog�S - <br /> Note any Equipment Washing <br /> Samples ColIected/Time ti- ' <br /> EVACUATION/STABILIZATION TEST DATA <br /> Temperature Cumulative <br /> Corrected Water Level Volume of Water Pumpzng <br /> pH Conductance Temperature (nearest Removed from Well Rate <br /> Ttme (units) (umhos/cm) (°C) 0 01 foot) (gallons) (gpm) <br /> Bailing Start Time WL <br /> Bailing Stop Time WL <br /> Comments ° StD <br /> Signature Date 11 lb 1 a� <br />