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Birch Technical 6ervices GRO UNDWAT ER SAMPLING FORM <br /> 116 Liberty Street <br /> Santa Cruz,Ca 95060 Well Number• <br /> (408)439-0718 — - <br /> Project Number: 10 ~0 Sample Type. groundwater OTnp Blank ODuplicate of <br /> St la Number: 1�� —�— <br /> Date: 1 12-4,l en Sampled by: <br /> WELL PURGING <br /> PURGE Casing Diameter (inches) 2" 03" 04" 04 S" 06" O <br /> VOLUME Volume Factors: a 1632 o 3672 0 6528 o 826 1469 <br /> Total Depth of Well initial Water Level:-c ' 3 PURGE METHOD: <br /> O Honda Pump <br /> Total Volume Purged: Time Elapsed ODisposable PolyTubing( _ ft) <br /> OSpeed Winch <br /> Calculated Purge Volume: ODisposable PVC Bailer(s)(,_,_� <br /> a OOther <br /> �3 = x - x (gallons) <br /> Total Depth Water Level Well Vol Fac #of vol to Purge Calculated Purge Volume <br /> COMMENTS: <br /> Sublective <br /> W " -7 SHEEN Depth to Product Product Thickness <br /> OYcs ONo (ft) (ft) <br /> • saw C� � , <br /> P <br /> SAMPLING METHOD <br /> OPVC Disposable Bailer Time Sampled <br /> OTeflon Bailer (24 bout dock) <br /> OOthcr kO T <br /> WELL SA_RELING PARAMETERS <br /> Gallons Temp Cond Analysis No. Contau-jer <br /> Removed Time pH "F (umhos/cm) Required of Ty Preservatives <br /> EPA 601 VOA's <br /> TPH-G/BTEX VOA's HCl <br /> TPH- Diesel Amber <br /> Liter <br /> TOG 5520 BF Amber H2SG4 <br /> Liter <br />