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01/03/2008 15:18 209835 5 2098350675 PAGE 15 <br />MONITORING WELL PURGE AND SAMPLING FORMENGEO' <br />! N C 0 R P© R A Z E t7 <br />Project: <br />Project No. Well ID <br />Location: <br />Technician: <br />Activity: Quarterly Sampling Develop/Sample <br />WELL SECURITY <br />Date <br />Well Box Set In Concrete? Yes No <br />Comments <br />Box Cover Equipped With Bolts and Gasket? Yes No <br />Well Casing Es i2pad With Well Seal and Lock? 'Yes No <br />WELL CONSTRUCTION AND WATER LEVEL RETAILS <br />Date <br />Well Type Monitoring Extraction Well with Pump L] <br />Other <br />Well Diameter Free Product Measurement <br />D'TW (fbtoc) (Enter measurements for wells with free product <br />histor ) <br />BOC (fbtoc) Entcr "0A" if no measurable free product ► <br />WCV Factors <br />WC, (f) DTi~P (fbtoc) <br />2" = 0.17 <br />WCV (gal) DTW (fbtoc) <br />4" = 0.66 <br />3 X, WCV (Purge Vol) FPT (1't) <br />6" = 1.50 <br />]PURGING, SAMPLING AND DECON <br />EQUIPMENT <br />Date <br />Purging: Disposable ® 12-V ® Subm. <br />Comments <br />Bailer Pump Pum <br />Sampling: 1"'I Disposable � 12-V Li Subrxt, <br />IJ <br />© <br />Other <br />Boiler Pum2 Pum <br />Decon: Was purge pump decontaminated before and attar chis use?] Yes <br />® No <br />Decon PrOC1110t: TSP/Alconox Decon Rinse: <br />PURGE WATER STORAGE/DISPOSAL (For Last Well Sampled Only) <br />]Date <br />Drums Onsite Arrival Drums All Labeled? Yes No (Attach Inventory) <br />Drums Used This Event Drums Lcakin ? Yes No <br />Gallons <br />Total Drums Onsite Now Purge Water Processed Through GWTS? <br />Yes <br />No <br />PHYSICAL PARAMETERS <br />Agte <br />Time Volume Tenip pH T:C Redox DO <br />J)TW <br />SQ% <br />Purged (C degrees) <br />Recovery <br />© Sample collected through groundwater treatment system using active ext.i-action pump; no purging required. <br />LABORATORY ANALYSIS <br />Numbcr/Type Containers E777VC)A's !-liter Ambers <br />500,1 Plastic <br />Preservative: <br />Analysis: <br />Laboratory/TAT <br />DTW = Depth to Water Noc = feet below lop orwtsing <br />130C = Bottom of Well Caging W(.'= Water Column Height <br />DTFP = Depth to Free Product WCv - Water Column Volume (gallons) r WC X WCV Factor <br />1n)'r -tree Product Thickness <br />