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GROUNDWATER SAMPLE COLLECTION DATA FORM <br /> SAMPLE I D. NO : .422 UL-5 WELL NUMBER. — <br /> DATE/TIME. - L 9Z x ' 9 WEATHER: Cl ear warms <br />' ANALYSIS. a n OraCT141C b <br /> WELL PURGING DATA: FILTERED? Yea No <br /> Initial depth to water: Filter Device- In-line <br />' Depth of well: Filter barrel <br /> Volume of water in well: Lab <br />' Date/time at start of purging- 17: Other <br /> Method of purging: /' <br /> Method of Decontaminating <br />' pur cequipment: <br /> ow .X . 9z 3 x ! <br />' WATER QUALITY OBSERVATIONS DURING PURGING: <br />' Volume Depth to <br /> Date/time purged water Temp. OF pH EC Umhos <br /> 73 <br /> 51.;L4 I.E Sr l�y <br />' 7 JR 12li <br />' SAMPLE CONTAINER DATA: SAMPLE METHOD- <br /> PUM <br /> Number/type of container: <br /> Other. <br />' VOA capacity: <br /> preserve: <br />' I Amber capacity oz <br /> presezve: - <br /> Plastic capacity: <br /> tpreserve: <br /> Other (describe): <br /> SAMPLE PRESERVATION METHOD. <br /> Iced Other (describe): <br /> Signature: DateMme: -9 Z /-3�° <br />' — Mardh L991 <br />