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GROUNDWATER SAMPLE COLLECTION DATA FORM <br /> SAMPLE I D NO . Z21t&2 - I WELL NUMBER: —I-- <br /> DATE/TIME- ti-b-9;? ZL Z o - WEATHER: Olen,, <br />' ANALYSIS o n O f N I C b <br />' WELL PURGING DATA. FILTERED? Yes ©o <br /> Initial depth to water: Filter Device: In-line <br /> Depth of well: Filter barrel <br /> Volume of water m well: ag I. Lab <br />' <br /> Date/tame at start of purging: f .�o- Other <br /> Method of purging: 22, Ie,- <br /> Method <br /> YrMethod of Decontaminating <br /> purging equipment: <br /> Al r/ 3 h D-1 _ . <br /> WATER QUALITY OBSERVATIONS DURING PURGING: <br /> Volume Depth to <br /> Date/time purged water Tem . OF pH EC Umhos - <br /> - . z <br /> 1! 30 a <br /> .5 <br /> 1 . '-ll jo d 0.97 <br /> SAMPLE CONTAINER DATA: SAMPLE METHOD. <br /> Number/type of container. <br /> Other. <br />' VOA capacity: <br /> preserve: <br /> Amber capacity: ox <br /> preserve: — o <br /> Plastic capacity: <br />' preserve: <br /> Other (describe): <br /> SAMPLE PRESERVATION METHOD: <br /> Iced Other (describe): <br /> Signature: DateMme: 9-8-Y_�t 11:y5_ <br /> Mach nN <br />