2005-11-16_REVISION - M2004078

• Permit No: M2004078
• IBM Index Class Name: Revision
• Doc Date: 11/16/2005
• Doc Name: Response to your Adequacy Review
• From: Civil Resources LLC
• To: DMG
• Type & Sequence: TR2
• Media Type: D
• Archive: No

GROUNDWATER SAMPLING
RECORD PAGE:_of:~
SAMPLE NUMBER:
Project No: Project Name:
Sampling Location (well ID, etc.):
Sampled by:
Measuring Point (MP) of Well:
Screened Interval (ft. BGLI:
Fitter Pack Interval (ft. BGL}:
Casing Stickup (ft.): Date
Starting Water Level Ift. BMP):
Total Depth Ift. BGL-: Water Column Height Ift): _
Casing Diameter tin tDl: _ Multiplication Factor:
Casing volume (gal.1: _ 2x: _ 3x _ 4x
Water Levet Ift. BMP} at End of Purge:
Total Depth Ift. BMP) at End of Purge:
QUALITY ASSURANCE
METHODS (describe):
Cleaning Equipment:
Purging:
Disposal of Discharged Water:
INSTRUMENTS (indicate make, model, i.d.):
Water Level:
pH Meter:
Conductivity Meter:
Filtration:

Sampling:

Thermometer:
Field Calibration:
Field.Calibration:
Other:
SAMPLING MEASUREMENTS
Purge Characteristics Water Quality Data Appearance
Date/
Time
Cumul.Vol.
Purge
Temp. Specific Conductance
Qrtnhos/cml
Tufiidity
Remarks
(gall Rate (gpm) l°CI PH @ Field Tamp. @ 26° C. Color & Sediment

Water Level Ift. BMP) at End of Purge: Sample Intake Depth (ft. BMP):
SAMPLE INVENTORY
Bottles Collected
Fihrati
n
Preservati
n
R
k

Time
Volume
Composition Iglass, plastic)
Quantity o
(Y/NI o
(typal emar
s
(quality control sample, other)

Chain-of-Custody Record No. Civil Resources, LLC
451 Oak Street, Suite 209
ABBREVIATIONS:
BMP • below measuring point C -Celsius
BGL -below ground level gal. -'gallons
Cumut. Vol. -Cumulative volume removed 9Pm -gallons per minute
ID -Inside Diameter - in. -inches P.O. BOX 6SO
FredefiCk, CO 50530
i