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RETTEW <br /> We answer to you, GROUNDWATER SAMPLING FORM Page 1 of_Ig_ <br /> Well No.: <br /> Well Type: Monitor ❑ Extraction ❑Other Dup: <br /> n MS/MSD: <br /> Job Name: Hokin Gulch Millsite#M-2009-076 Well Material: ❑PVC ❑St Steel/ Other DL,C <br /> Job Number: 107732000 Phase Date: /D Io l/Z Time: //?r7 <br /> Recorded By: G .l t� Sampled By: <br /> (Signature) (Sampling Team Members) <br /> PURGE VOLUME „ PURGE METHOD <br /> Casing Diameter(D in inches): P13ailer-Type: <br /> Total Depth of Casing(TD in feet BTOC): Z 3• ❑Submersible❑Peristaltic❑Bladder,Pump No.: <br /> Water Level Depth(WI.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 /> ( )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 (mIJ Purged (mS/cm) (NTUs) (mg/L) (CC) (MV) Water Comments <br /> min) (ft t.o.c.) <br /> 12 <br /> is <br /> 21 <br /> 24 <br /> 27 <br /> 30 <br /> Note: GT=Oreater nam LT m L=Tban. <br /> NM=Not Measured. NC=NotColloctcd. <br /> OBSERVATIONS DURING WELL PURGING: Well Condition: j0d Color: <br /> Turbidity(Qualitative): Odor. / Other: <br /> Purge Water Disposal: ❑San.Sewer ❑Storm Sewer ❑Bucket:Type Size, Other: <br /> SAMPLE COLLECTION RECORD <br /> Analysis <br /> Notes: <br /> Y <br /> Form Printed: October 6,2017 <br />