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T <br /> L ILLCO ENGINEERING, INC <br /> RCI;#27011 Lsc #537901 ' <br /> 6084 Old Aubum Rd,Suite E Citrus Heights,CA 95610 <br /> WELL DEVELOPMENT/SAMPLING DOCUMENTATION FORM ' <br /> Protect Name Jeb# 5'�. 9 Well# P"W-4 <br /> Date Z��1b 0 * ' <br /> Sample[D ��' <br /> Sampling Team <br /> Purpose of Sampling ❑ Initial V-auarterty ❑ Venficabon ❑ Other <br /> Weather Condrtions ' <br /> GROUNDWATER LEVEL/CASING VOLUME ' <br /> F—DeZnptlon Time Depth i Conversion Casing <br /> (TOC to GW} Total Depth Feet of Water I Factor TVolume <br /> Initial III (ft to als) ( allcns) ' <br /> After Development/ eM440 I� <<o <br /> Pur sn {{� <br /> At Time of <br /> Sam lin t{� /� Three Casing Volumes Cats ' <br /> Ten Casing Volumes �_GalS <br /> WELL DEVELOPMENT/PURGING ' <br /> Equipment XSubmers:ble Pump ❑ Bader ❑ Sandpiper <br /> �`' P P ❑ Other <br /> Method Z�Q?ir�� :� <br />� �� escnpnan ' <br /> Cecontarn,nation Method 16 V-"bp- <br /> ascnpuon <br /> Dater Containment XDtims ❑ Baker Tank <br /> ❑ Treatmen#System ❑ Other <br /> Labeled <br /> Start Time Volume Water Tempe e � <br /> Extracted 'F C (umbos) pH Observations ' <br /> ` (Color,Turbitity Oils,Odor) <br /> SAMPLE INFORMATION , <br /> Lab >IeWN <br /> Sampling Contwners/No of Containers <br /> ❑ 1 Utar Amber Preseivahon <br /> 40 int VO Ice ❑ Other <br /> Other Ice ❑ Other ' <br /> Device <br /> Bailer,Disposable F-1 Other ❑ Ice ❑ Other <br /> Pertinent Feld Observations <br />_e nations From Standard Sampling Protocol �} <br /> 1 <br />