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1 <br />i <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />1 <br />WATER SAMPLE FIELD DATA SHEET Rev. 5/96 <br />PROTECT NO: <br />SAMPLE ID : ' <br />PURGED BY: <br />CLIENT NAME: <br />SAMPLED BY: <br />LOCATION: <br />TYPE: Groundwater Surface Water <br />Leachate Other <br />CASING DIAMETER (inches): 2 3 <br />4 4.5 6 Other <br />CASING ELEVATION (feet/MSL): <br />VOLUME IN CASING (gal.) : <br />DEPTH OF WELL (feet) : <br />CALCULATED PURGE (gal.) : <br />DEPTH OF WATER (feet) : <br />ACTUAL PURGE VOL. (gal.) : <br />DATE PURGED: END PURGE: <br />DATE SAMPLED: SAMPLING TIME: <br />771VB VOLUME pH E.C. TEMPERATURE TURBIDITY TIME <br />(2400 HR) (gal.) (units) (pmhos/cm 75°c) (°F) (visaal/xTt)) (240D RK <br />OTHER: <br />-ODOR: <br />(cosaLTo•loo) (xTDo-zoo) <br />FIELD QC SAMPLES COLLECTED AT THIS WELL (i.e. FB -I, XDUP-I) : <br />PURGING EQUIPMENT <br />SAMPLING <br />EQUIP NT <br />2" Bladder Pump <br />Bailer(Tenon) <br />2" Bladder Pump <br />Baiter (Teflon) <br />Centrifugal Pump <br />Bailer (PVC) <br />Bomb Sampler <br />Bailer (Stainless Steely <br />Submersible Pump <br />Bailer (Stainless Steel) <br />Dipper <br />Submersible Pump <br />WellWirard' <br />Dedicated <br />WellWitard- <br />Dedicated <br />Other. <br />Other: <br />WELL INTEGRITY: LOCK: <br />REMARKS: <br />pH, E.C-, Temp. Meter Calibration: Date: Time: Meter Serial No_: <br />E.C. 1000 / pH 7 / pH 10 / pg 4 / <br />Temperature "F <br />SIGNATURE: REVIEWED BY: PAGE OF <br />FIGURE <br />IWATER SAMPLE FIELD DATA SHEET • <br />