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RETTEW <br /> We answer to you. GROUNDWATER SAMPLING FORM Page I of_I_ <br /> {p"7le [J <br /> Wellako: <br /> Well Type:/❑ Monitor ❑ Extraction ❑Other Dup: <br /> MS/MSD: <br /> Job Name: Hukill Gulch Miltsitc#M-2009-076 Well Material: ❑PVC ❑St.St I (a Other <br /> Job Number. 107732000 Phase Date: —r�'7—t `— Time: <br /> Recorded By: Sampled By: <br /> (Signature) (Sampling Team Members) <br /> PURGE VOLUME PURGE METHOD <br /> ,Casing Diameter(D in inches): ❑Baiter-Type: <br /> Total Depth of Casing(TO in feet BTOC): ❑Submersible❑Peristaltic❑Budder;Pump No.: <br /> Water Level Depth(WL in feet BTOC): Other-Type: <br /> Number of Well Volumes to be Purged. PUMP INTAKE SETTING <br /> Screened/Open Interval in Feet(BTOC)from —to ❑Near Bottom ❑Near Top ❑ Middle of water column ❑ Other: <br /> Depth in feet(BTOC) <br /> PURGE VOLUME CALCULATIONS <br /> t )X 2 X _ X 0.0408= _ Gallons <br /> TO(feet) WL(feet) D(inches) No.Volumes Calculated Paige Volume <br /> FIELD PARAMETER MEASUREMENT <br /> iMinutes Rate Gallons pH Cond. Turbidity DO Temp ORP Depth to <br /> Time Elapsed (mIj Purged (ntS/cm) (NTUs) (mg/L) (°C) (mV) Watet Comments <br /> 1 min) (ft t.o.c.) <br /> 12 <br /> 5 <br /> 71 <br /> 24 <br /> 27 <br /> 30 <br /> Note: GT=Greater Than. LT=Less 1 lian <br /> NM=Not Measurcdd NC Not Collected. <br /> OBSERVATIONS DURING WELL PURGING: Well Condition: Color:.--- <br /> Turbidity(Qualitative): Odor:_ ___ _ Other- <br /> Purge Water Disposal: ❑San.Sewcr ❑Storm Sewer ❑Bucket•Type Size_ Other _ <br /> SAMPLE COLLECTION RECORD <br /> Analysis <br /> Notes: <br /> Y iza i�of O�+ L tJ' P f7, nL <br /> f <br /> Form Printed: October 31,2016 <br />