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1tTTE1 <br /> We answer to you. GROUNDWATER SAMPLING FORM Page 1 of90 whOlejt <br /> Well/ o.: <br /> Well Type:/Monitor 0 Extraction 0 Other Dap: <br /> �,/� MS/MSD: <br /> Job Name: Hukill Gulch Millsite#M-2009-076 Well Material: ❑PVC 0 St.Steel Other 0 0`'r <br /> Job Number: 107732000 Phase Date: is/;1/f v Time: II 311'" <br /> Recorded By: Sampled By: 4‘04 <br /> (Signature) (Sampling Team Members) <br /> PURGE VOLUME p PURGE METHOD <br /> Casing Diameter(D in inches): Z i. fX1ailer-Type: <br /> Total Depth of Casing(TD in feet BTOC): Z 3. D Submersible 0 Peristaltic 0 Bladder;Pump No.: <br /> Water Level Depth(WL in feet BTOC): Wit Other-Type: <br /> Number of Well Volumes to be Purged: PUMP INTAKE SETTING <br /> Screened/Open Interval in Feet(BTOC)from to _ 0 Near Bottom 0 Near Top 0 Middle of water column 0 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 (roll Purged (mS/cm) (NTUs) (mg/L) (°C) (mV) Water Comments <br /> min) (ft t.o.c.) <br /> 0 <br /> 3 <br /> 6 <br /> 12 pry <br /> 15 <br /> I8 <br /> 21 <br /> 24 <br /> 27 <br /> 30 <br /> Note: GT=Greater Than. LT=Less Than. <br /> NM=Not Measured. NC=Not Collected. <br /> OBSERVATIONS DURING WELL PURGING: Well Condition: Color: <br /> Turbidity(Qualitative): Odor: Other: <br /> Purge Water Disposal: 0 San.Sewer 0 Storm Sewer ❑Bucket:Type Size Other: <br /> SAMPLE COLLECTION RECORD <br /> Analysis <br /> Notes: <br /> y - ass et ose, ,vIe <br /> Form Printed: October 31,2017 <br />