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I <br /> WELL SAMPLE FIELD LOG <br /> i <br />' Date: ( .� �CK� Well No, 010 3_ <br /> ,lob Name: <br /> rt1 �� " �� L.,t?�� ,lob No:_ ,O <br />' Technician:EL , t — Weather: <br />' Well Casing Diameter: 02" 04" ❑6" E]other: <br /> Well Head Protection: Z OK ❑Needs Following Repairs: <br />' DTGW .'7? Total Well Depth ZS.L(r Free Product Thickness • Well Under Pressure ❑Yes [3N0 <br /> Discoloration: fJC,;L— Odor:_���a tE~ _ Sediments in Well Water ❑Yes 0 No <br />' Well Purge Equipment: Purge Volume (gal): O <br /> Purge Water Disposition toj u,., Well Dewatered ❑Yes ZNo <br /> F0IojTime=Vo1ume (9al Tem °C Cond. slcm H ORP my�ZS <br /> r � i �`i3 �•. y <br /> Water Sample EquipmentSample Time: f <br /> Sample Containers: ❑1 Liter Amber Placed on Ice: ®Yes ❑No <br /> 0250 ml Chain of Custody: 0Yes ❑No <br /> ❑Unpreserved VOA's Laboratory: ❑KIFF ZTEG <br /> Preserved VOA's ❑Other: <br /> ❑ Plastic <br /> Comments: <br /> Technician Si nature: <br /> g i <br /> Rev:318140 TM <br />