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i <br /> RETTEW <br /> We answer to you. GROUNDWATER SAMPLING FORM <br /> Page 1 of_1 <br /> Well Type: Monitor ❑ Extraction ❑Other Well No.: <br /> Dup: <br /> / ALS/II—SD: <br /> Job Name- Hukill Gulch Millsite#M-2009-076 Well)Material: ❑PVC ❑St. tee) �Otlrcr t`►��F <br /> lob Number: 107732000 Phase } <br /> Date: `/ Time: 1200 <br /> Recorded By: Sampled By: 545 fI►C4 j <br /> i <br /> (Sigttatme) (Sampling Team Members) <br /> PURGE VOLUME PURGE METHOD <br /> Casing Diameter(Din inches); 't t! <br /> ., arler-Type: <br /> Total Depth of Casing(TD in feet BTOC): ems'3 ❑Submersible❑Peristaltic❑Bladder;Pump No.: <br /> Water Level Depth(WL in feet BTOC):_� Other-Type: <br /> Number of Well Volumes to be Purged; _ PUMP INTAKE SETTING <br /> Screetied/Open Interval in Feet(BTOC)from to ❑Near Bottom ❑Near Top ❑ huddle of water column ❑ Other: <br /> Depth in feet(BTOC) <br /> i PURGE VOLUME CALCULATIONS i <br /> ( )x 'X x 0.0408- <br /> TD(fee() WL(feet) D(inches) No.Volumes Gallons <br /> Calculated Purge Volume <br /> FIELD PARAMETER MEASUREMENT <br /> Minutes Rate Gallons Of Cond. Turbidity DO Temp, ORP Depth to <br /> Time Elapsed (mu Purged (ins/cm) (NTUs) (mg/L)min) (°C) (mV) Water Comments <br /> (ft t.0 C.) <br /> 12 <br /> 19 <br /> 21 <br /> 24 <br /> 27 <br /> 1 <br /> 5 <br /> I <br /> 30 <br /> Note: GT=Greater Than. LT=Less Than. <br /> NM=Nat Measured NC=Not Collected. <br /> OBSERVATIONS DURING WELL PURGING: Well Condition:` Ce Color: <br /> Turbidity(Qualitative): Odor: V Other: <br /> Purge Water Disposal: ❑San.Seger ❑Storm Sewe, ❑Bucket:Type Size_ Othec <br /> SAMPLE COLLECTION RECORD <br /> Analysis <br /> Notes: <br /> I <br /> V P— 1 <br /> 1 <br /> i <br /> Form Printed: February 28,2017 <br />