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ACTON • MICIKELSON • van DAM, INC. <br /> SAMPLING/DEVELOPMENT INFORMATION <br /> Project Name yqy <br /> Sampling/Development Point T\f\"1 <br /> Sample I D Project No _ 1°Ir�`J5 O`�o <br /> Descnbe Sampling/Development Point Work Order # <br /> Date_ <br /> Field Crew SZS. <br /> 1� <br /> Well Depth $3 feet below MP Casing Diameter y inches <br /> Depth to Water (below MP) feet <br /> Discharge Rate gpm Time AM/PM <br /> Number of borehole volumes <br /> evacuated before sampling LA <br /> Sampling/Development Method <br /> Tap Bailer Centrifugal Pump <br /> Submersible Other <br /> Pump intake or bailer set at feet below MP <br /> Sample Appearance {L <br /> Note any Sampling Problems <br /> 4Note any Equipment Washing <br /> Samples Collected/Time <br /> EVACUATION/STABILIZATION TEST DATA <br /> Temperature Cumulative <br /> Corrected Water Level Volume of Water Pumping <br /> pH Conductance Temperature (nearest Removed from Well Rate <br /> Time (units) (umho91cm) (°C) 0 01 foot) (gallons) (gpm) <br /> Bailing Start Time WL <br /> Bailing Stop Time WI- <br /> Comments <br /> - Signature /�� �] Date <br />