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RE' W <br /> We answer to you. GROUNDWATER SAMPLING FORM <br /> Page L of_]_ <br /> �'#' •.. r.j <br /> Well Type: Mon ❑Other itor ❑ Extraction Welo.: <br /> Dup- <br /> /� p nlsnvlsn: <br /> Job Name:_Flukili Gulch Millsite#M-2009-076 Well Material• ❑PVC ❑S.St el (f�Other / �! <br /> Job Number, 107732000 Phase <br /> Date: � Time. <br /> Recorded By:_ Sampled By: M.sTe <br /> (Sigttafure) (Sampling Team Members) <br /> PURGE VOLUME r� P�JRGE METHOD <br /> Casing Diamcter(Din inches). 7- RR ¢ Bailer-Type: <br /> Total Depth of Casing(TD in feet BTOC):_23•O ❑Submersible❑Peristaltic❑Bladder;Pump No: <br /> Water Level Depth(WL in feet BTOC): �/_._ Other-Type: <br /> Numbet of Well Volumes to be Purged: PUMP INTAKE SETTING I <br /> Screened/Open Interval in Feet(BTOQ fiom to ❑Near Bottom ❑Near Top ❑ Middle of water column ❑ Other: <br /> Depth in feet(BTOC) <br /> PURGE VOLUME CALCULATIONS <br /> ( )X-'X X 0 0408= Gallons <br /> TD(feet) WL(feet) D(inches) No.Volumes Calculated Purge Volume ' <br /> FIELD PARAMETER MEASUREMENT j <br /> ffMi'nutes Rate Gallons pll Cond. Turbidity DO Temp. ORP Depth to <br /> (mu Paged (ntS/cm) (NTUs) (mg/L) (°C) (mV) Water Commentsmin) (ft t.o C.) <br /> i <br /> 5 i <br /> i <br /> i <br /> 30 I <br /> Note:G1'=0reater Than. LT=Less Than <br /> NM=KotMensurcd. NC=Not Collected. <br /> OBSERVATIONS DURING WELL PURGING, Well Condition: lit/ <br /> TurbidityColor: <br /> (QualilaEivc): Odor. Other: <br /> Purge Water Disposal: ❑San.Sewer ❑Storm Sewer ❑Bucket Typc Size^ Olher. <br /> SAMPLE COLLECTION RECORD <br /> Analysis i <br /> Notes: / <br /> I <br /> I <br /> i <br /> Form Printed• June 29,2017 ! <br />