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RETTEW <br /> We answer to you. GROUNDWATER SAMPLING FORM Page 1 of—I— <br /> Well No.:dd <br /> Well Type: Monitor ❑ Extraction ❑Other Dap: <br /> (� MS/MSD: <br /> Job Name: Hukill Gulch Millsite#M-2009-076 Well Material: ❑PVC S. e Other <br /> Job Number107732 Phase Date: �� Time: <br /> / ^ <br /> Recorded By: Sampled By: Da <br /> (Sig»eture) (Sampling Tenth Members) <br /> PURGE VOLUME ii PURGE METHOD <br /> Casing Diameter(D in inches): f > Bailer-Type: <br /> Total Depth of Casing(TD in feet BTOC}: 04 ❑Submersible❑Peristaltic❑Bladder,Pump No.: <br /> Water Level Depth(WL in feet BTOQ): Other-Type: <br /> Number of well Volumes to be Purged: PUMP INTAKE SETTING <br /> Screened/Open Interval in Feet(BTOC)from to ❑Near Bottom CI Near Top ❑ Middle of water column ❑ Other: <br /> •0r f HsK Depth in feet(BTOC) <br /> PURGE VOLUME CALCULATIONS <br /> ( )X 2 X X 0.0408= Gallons <br /> TD(feet) WL(feet) D(inches) No.Volumes Calculated Purge Volume <br /> FIELD PARAMETER MEASUREMENT <br /> Minutes Rate Gallons pH Cond. Turbidity DO Temp. ORP Depth to <br /> Time Elapsed (mI/ Purged (mWern) (NTUs) (mg/L) ('C) (mV) Water Comments <br /> min) (ft t.o.c.) <br /> 12 <br /> 15 <br /> 19 <br /> 21 <br /> 24 <br /> 27 <br /> 30 <br /> Now GT=Gmatw Than. LT=Less Than. <br /> NM=Not Mcmm& NC-No CoNected. <br /> OBSERVATIONS DURING WELL PURGING: well condition: job Color: <br /> Turbidity(Qualitative): Odor: Y Other: <br /> Purge Water Disposal: ❑San.Sewer ❑Storm Sewer ❑Bucket:Type Size_ Other: <br /> SAMPLE COLLECTION RECORD <br /> ArLalysis <br /> Notes: <br /> yL /'�a.'S d-trvt Flh. lob C <br /> Form Printed: November 22,2016 <br /> Form Printed: November 22,2016 <br />