HYDRO30826

• Permit No: C1981015
• IBM Index Class Name: Hydrology
• Doc Date: 11/16/1980
• Doc Name: WATER SAMPLE COLLECTION FORM
• Permit Index Doc Type: OTHER GROUND WATER
• Media Type: D
• Archive: No

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ER SAMPLE COLLECTION FORM•
.. • III IIIIII'II I~II'll
~1~~ Date fynv_ tb~98o ~ -
l Name ofhPerson Taking Samples
Surface Water Ground Water Depth to No. of
Monitoring location Monitoring Well No. Water Level Samples Temp.
'J = oE3o
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5.
M - _~
~. 7 ~ '~-'
l7 r .--_

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6.
C1~1-7
I z~~z"
1.
~t'f
los.}

I-2c~3
8. (J eq.~ Iti~-1 -- '.. ~ j~
tilt) ~=0~oM tlr~L
9 - ~ _ ~, N ,. ~a~1
~10.
11.
12.
Ground Water Monitoring Well Information:
Well Designation Strata Penetrated Deoth Perforated Interval _.
NO stf~eat_,n~ t\o.J f~CcC~~ ~~7o~c ~.~VY ~..~ck div~,h5iorl
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