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i <br /> HETTEW <br /> We answer to you. GROUNDWATER SAMPLING FORM <br /> Page 1 of_1__ <br /> Well Well No.: ' <br /> type: Monitor ❑ Extraction El Other Pup. � <br /> MS/i41Sll: <br /> Job Name: ilnkill Gulch Millsite#M-2009-076 Well Material: ❑PVC ❑St,steel ,�Oiher Opt <br /> Job Number: 107732000 Phase Date: `w-1--1 Tirue: <br /> Recorded By- Sampled k <br /> By: l <br /> (Sigttaffire) (Sampling Team A4embers) <br /> PURGE VOLUME PURGE METHOD <br /> Casing Diameter(D in inches)• '2 tr Cutler-Type: <br /> Total Depth of Casing(TD in feet BTOC): S 3 17 Submersible El Peristaltic❑Bladder;Pump No,: <br /> Water Level Depth(WL in feet BTOC): Y _ 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 hate Gallons pH Cond. Turbidity DO Temp. ORP Depth to <br /> Time Elapsed (mU Purged (MS/cm) (NTUs) (mg/L) (°C) (mV) Water Comments <br /> min) ` <br /> (ft <br /> 30 <br /> Note:GT Gmatcrthen Ur=Less Than. <br /> NM=Not.Lteasumd. NC_Not Collcocd <br /> OBSERVATIONS DURING WELL PURGING: Well Condition: 1,04?&0 Color: <br /> Turbidity(Qualitative): Odor: ✓ Other. <br /> Purge Water Disposal: ❑San,sewer ❑ ❑ <br /> Storm Sewer Bucket:Type Size` Other_ <br /> SAMPLE COLLECTION RECORD <br /> Analysis <br /> I <br /> Notes: <br /> 1 <br /> I <br /> E::= <br /> iForm Printed: March 30,20 L7 <br /> I <br />