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BETTER <br />We answer to you. GROUNDWATER SAMPLING FORM Page i of —I— <br />I/ Jl c� <br />.: <br />Well Type: Ytonilor ❑ Extraction ❑ Other Dup; <br />,(� b MSIMSD: <br />Job Namc: u ' u It -2 Well Material. ❑PVC ❑ St. Steel x Othcr r' 19 1F <br />Job Number IM32 Phase Date; Time: )i1 b <br />Recorded By: Sampled By: <br />(Signature) <br />PURGE VOLUME z t� <br />Casing Diameter (D in inchrs): <br />Total Depth of Casing (TD in feet BTOC): Zf • 3 r <br />Water Level Depth (WL in feet BTOC): -�GF <br />Number of well Volumes to be Purged: <br />ScreeneNOpen interval in het (BTOC) from_ to _ <br />('6 ` �- r <br />(Sampling Tenni Members) <br />PU GE METHOD - — <br />ailer- Type:., _. <br />❑ Submersible O Peristaltic ❑ Bladder; Pump No.: <br />Other-Typc:.. _ <br />PUMP INTAKE SETTING <br />❑ Near Bottom © Near Top ❑ Middle of water column i3 Other. <br />Depth in f t (BTOC) <br />PURGE VOLUME CALCULATIONS <br />( <br />)X z 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 Gond, Turbidity DO Temp. ORP Depth to <br />Time Elapsed (mL/ Purged (m51cm) (NTUs) (mg/L) (°C) (mV) Water Comments <br />min) (ft I.o.c.) <br />74 <br />27 <br />30 <br />Note: cr a GmterT6aa. LT u tsaThm <br />NM- Not Aleammd. NC:NotColkcL%L <br />OBSERVATIONS DURING WELL PURGING: Well Condition: Color. <br />Turbidity (Quaiitalive): Odor. Other: <br />Purge Water Disposal: ❑ San. Sewer ❑ Storm Sewer OBucket: Type Size Other: <br />SAMPLE COLLECTION RECORD <br />Analysis <br />Notes: <br />DP y - ^a )n 0 404 AL, FM 4& <br />Form Printed: Dccember 29, 2016 <br />