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MONITORING WELL PURGE AND SAMPLING FORM CPEO <br /> I N C O R P O R A T E D <br /> Project: <br /> Project No. well ID <br /> Location: <br /> Technician: <br /> Develop/Sample <br /> Activity: E]Quarterly Sampling <br /> Date <br /> WELL SECURITY <br /> Yes No Comments <br /> Well Box Set in Concrete? <br /> Box Cover Equipped With Bolts and Gasket? Yes No <br /> Well Casing Equipped With Well Seal and Lock? Yes No <br /> WELL CONSTRUCTION AND WATER LEVEL DETAILS Date <br /> Well Type ❑ Monitoring LJ Extraction Well with Pump ❑ Other <br /> Well Diameter Free Product Measurement <br /> DTW(fbtoc) (Enter measurements for wells with free product history) <br /> BOC(fbtoc) Enter"0.0" if no measurable free product —► " = Factors <br /> WC(f) DTFP(fbtoc) 2" = 0.17 <br /> WCV(gal) DTW(fbtoc) 4" = 0.66 <br /> FPT(ft) 6" 1.50 <br /> 3 X WCV(Purge Vol) = <br /> PURGING, SAMPLING AND DECON EQUIPMENT Date <br /> Purging: El Disposable El12-V ❑ Subm. Comments <br /> g g� <br /> Bailer Pump Pum <br /> 12-V Subm. Other <br /> Sampling: F-1Disposable ❑ ElElBailer Pum Pum <br /> Decon: Was purge pump decontaminated before and after this use? ❑ Yes ❑ No <br /> Decon Product: TSP/Alconox Decon Rinse: <br /> PURGE WATER STORAGE/DISPOSAL (For Last Well Sampled Only) Date <br /> Drums Onsite Arrival Drums All Labeled? Yes No (Attach Inventory) <br /> Drums Used This Event <br /> Drums Leakin ? Yes No Gallons <br /> Total Drums Onsite Now Purge Water Processed Through GWTS? Yes No <br /> PHYSICAL PARAMETERS Date <br /> Time Volume Temp pH EC Redox DO DTW 80% <br /> Purged (C de rees) Recover <br /> ❑ Sample collected through groundwater treatment system using active extraction pump;no purging required. <br /> LABORATORY ANALYSIS <br /> Number/Type Containers <br /> VOA 7s <br /> 1-liter Ambers 500m1 Plastic <br /> Preservative: <br /> Analysis: <br /> Laboratory/TAT: <br /> fbtoc=feet below top of casing <br /> DTW=Depth to Water <br /> BOC=Bottom of Well Casing WC=Water Column Height <br /> DTFP=Depth to Free Product <br /> WCV=Water Column Volume(gallons)=WC X WCV Factor <br /> FPT=Free Product Thickness <br />