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g GROUND-WATER SAMPLING FORM <br /> Harding Lawson Associates <br /> Engineering and 1 !� <br /> Environmental Services Well No L <br /> I*Job Number T d j Well Material XPVC 0 ob Name `r��r Well Type Monitor ❑ Extraction ❑Other <br /> 3 V 7� 1 St Steel ❑ Other <br /> �- Date Time j <br /> ' Recorded by 1_5_:�57 < Sampled by <br /> (SVwUr pnrnPlsl <br /> 01� A i y',��'"`3 <br /> PURGE VOLUME 0� <br /> C sing Diameter(D in inches) Type V C <br /> 2 inch ❑4 inch ❑6-inch ❑Other )Bader <br /> Submersible ❑Centrifugal J Bladder, Pump No <br /> ' otal Depth of Casing(TD in feet STOIC 0 Other Type <br /> Water Level Depth (WL in feet BTOC) pUP INTAKE SETTING <br /> Number of Well Volumes to be purged(#Vols) -1 C3 N <br /> C]3 O 4 p 5 11 10 fl Other !a Near Bottom C3 Near Top ❑Other <br /> Depth in feet(BTOC) Screen Interval in Feet(BTOC) <br /> PURGE VOLUME CALCULATION; from to <br /> r - r—tel X X X 0 0408 = gallons <br /> TD (feet) WL(feet) I D ( es) #Vols Calculated Purge Volume <br /> P)IR E TMME LACTUAL PURGE,* L�J E <br /> ' ]_Z Start Stop Elapsed Initial gpm Final gpm gallons <br /> (E © PAfAME`I"ER MEAa�EJII+ EN ' <br /> Minutes Since Cond ❑'C Minutes Since Cond ❑°C <br /> Pumping Began pH (µmhos/cm) T❑°F Other Pumping Began pM (µmhos/cm) T❑°F Other <br /> ( Meter Nos <br /> ' Observatio s Dunng Purging (Well Condition, Turbidity, Color Odor) <br /> Discharge Water Disposal ❑ Sanitary Sewer ❑ Storm Sewer Other <br /> L » <br /> SAMPLI[dG ME=O ❑ Same As Above <br /> Bailer-Type J y ❑ Grab-Type <br /> ' ❑ Submersible ❑ Centrifugal ❑ Bladder, Pump No ❑ Other-Type <br /> SA PIIN p( ,1{UTV�4, Sample Series <br /> ' Sample No Volume/Cont Analysis Requested Preservatives Lab Comments <br /> 1 <br /> 1 <br /> QUALi�r c NT.Ro L <br /> Duplicate Samples Blank Samples Other Samples <br /> Original Sample No Duplicate Sample No Type Sample No Type Sample No <br /> ' RL004 OFFICE COPY WHITE FIELD CoPY CMRy Q746 <br />