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ACTON • NIICHELSON • van DAM, INC. <br /> SAMPLLNG/DEVELOPMENT INFORMATION <br /> Project Name4�! <br /> Sampling/Development Point rrtit.r-5 <br /> Sample I D Project No <br /> Describe Sampling/Development Point Work Order , <br /> .a Date l� V A� <br /> Field Crew—� <br /> ff <br /> Well Depth _$3 feet below MP 1 Casing Diameter LA inches <br /> Depth to Water (below MP)_ toq._(i -j feet <br /> Discharge Rate gpm Time <br /> Number of borehole volumes <br /> evacuated before sampling > 3 <br /> Sampling/Development Method 3 D�PosA4�.E <br /> Tap _�C Bailer Centrifugal Pump <br /> Submersible Other <br /> Pump intake or bailer set at feet below VIP <br /> Sample Appearance Lo-WL <br /> Note any Sampling Problems <br /> Mote any Equipment Washing _ niEu-)rA _ <br /> Samples Collected/Tune <br /> EVACUATION/STABILIZATION TEST DATA <br /> Temperature Cumulative <br /> Corrected Water Level Volume of Water Pumping <br /> pH Conductance Temperature (nearest Removed rrom Well Rate <br /> Time (units) (umhos/cm) (°C} 0 01 foot) (gallons) (gpm) <br /> 12• to -7 5 (, <br /> ��•. 7.5 -7 (, 5 5 a► 6 . Z tq <br /> �V. Ll5 -I . 60 5 .q5 L C, . 0 ZS <br /> l <br /> C <br /> Bailing Start Time �-' �� WL X00%. (03! <br /> Bailing Stop Time WL '10-LL's <br /> Comments <br /> Signature Date <br />