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1"RIE TEW <br /> We answer to you. GROUNDWATER SAMPLING FORM Page 1 of_I <br /> Well Type: Monitor ❑ Extraction ❑ Well No.: <br /> _ Dup: <br /> )' rY1S/MSD. <br /> Job Name: Hukill Gulch Millsite#M-2009-076 Well Material: ❑PVC ❑St,Sleet 13 Other K <br /> Job Number: 10773200 Phase Date: Or 7D 1 Time: 7qr- <br /> Recorded By: Sampled By: <br /> (Signature) (Sampling Team Members) <br /> PURGE VOLUME r PU�tGE METHOD <br /> Casing Diameter(D in inches): _ r Barter-Type: <br /> Total Depth of Casing(TD infect BTOC): '�J•) ❑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 j <br /> Screened/Open Interval in Fect(BTOC)from to ❑Near Bottom ❑Near Top ❑ Middle of water column ❑ Other. <br /> Depth in feet(BTOC) <br /> PURGE VOLUME CALCULATIONS <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 /> f <br /> Minutes Rate Gallons pH Cond. Turbidity DO Temp, ORP Depth to <br /> Time Elapsed (mU Purged (mS/cm) (NTUs) (mg/L) (IC) (mV) Water Comments <br /> min) (ft t.o.c.) <br /> 3 � <br /> 12 <br /> 18 <br /> 21 <br /> 94 <br /> I <br /> 30 i <br /> Note Gr-Greaterlhan LT-Less Than <br /> N14=NolNfensuroi. NC=Not Collected, <br /> OBSERVATIONS DURING WELL PURGING: Well Condition- Color. <br /> Turbidity(Qualitative): Odor. Other. — - <br /> Pruge Water Disposal: ❑San Sewer ❑Stoun Sewet ❑Bucket:Type Size, Other: <br /> SAMPLE COLLECTION RECORD <br /> Analysis <br /> i <br /> Notes: <br /> ff r <br /> "61 f.o tic <br /> 1 <br /> i <br /> J� <br /> Form Printed- August 30,2017 <br />