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Sde Address )q U S. �[ 4 � Site Number <br /> 0� Pro)ec,l No �� <br /> i <br /> Project Manager �� � Project PM <br /> Sde Contact&Phone Number Site Sampled By [ (LL Dale Sampled •d <br /> Water Level Data Purge Volume Calculations I-Sampliny Analytes Sample Record <br /> Tpp of Total CasingI Three Actual Other <br /> Depth to Screen Depth of :Re <br /> heck rf Water Well Multiplier Casing Waller UTEX TPIi-g MTBE Dissolved Sample <br /> Water interval Well rge Not Column Diameter Value Volumes Purged (8020) (8015M) (8020) ------ Oxygen Freqency Sample Sample <br /> Well ID 1 mle (feel) (feel) (feel) quired (A) (Inches) (13) (gallons) (gallons) VOA VOA VOA (mg/L) (A,S,Q) I D Time <br /> ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> El ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ' <br /> ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ 1 ❑ ❑ ❑ <br /> A)Gasmg Water Column Depth to Button,-Depth to Water (B)Multiplier Values (2"Well 0 5) (4"Well 2 0) (0"Well 4 4) Sampling Sequence Annual <br /> Quar larly <br /> Sampling Notes List de th of Sample on C O C I e MW 11M] Mako Swe to Note on C 0 C "Provide Lowest Re or hipg LinM Available" Ori mal Co res of FieldSainyhog Sheets are Located in Pro act File <br /> If the water level is below the tap of llie screen lake a grab sample and check box ror NO PURGE(NP) If(lie water level is above ilia screen purge as normal <br /> TLA( Blank Sampbng Sheets XLS) (Page 1 of 2) Last Printed 1112101 <br />