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RETTE1t <br /> We answer to you. GROUNDWATER SAMPLING FORM Page 1 of_1_ <br /> UprduJ <br /> Well No.. <br /> Well Type:/121-"Monitor 0 Extraction ❑Other Dup: <br /> 1 MS/MSD: <br /> Job Name: Hukill Gulch Millsite#M-2009-076 Well Material: OPVC 0 St.Steel ,8'Other <br /> Job Number: 107732000 Phase Date: /0/I(//i Time: /7 f <br /> Recorded By: `�—� Sampled By: <br /> (Signature) (Sampling Team Members) <br /> PURGE VOLUME PURGE METHOD <br /> Casing Diameter(D in inches): q ler-Type: <br /> Total Depth of Casing(Ti)in feet BTOC): Z f'7 0 Submersible 0 Peristaltic❑Bladder;Pump No.: <br /> Water Level Depth(WL in feet BTOC): 1 r 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 ❑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 (mU Purged (mS/cm) (NTUs) (mg/L) (°C) (mV) Water Comments <br /> min) (ft t.o.c.) <br /> 0 <br /> 3 <br /> 6 <br /> 9 <br /> 12 <br /> vr _y <br /> IS <br /> 18 <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 /> Q12 t/ <br /> (hid Or, r#-ib c .I r pt <br /> L e y 14,0 Y[(MAY ail IA' <br /> Form Printed: October 31,2017 <br />