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ID i <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> ProlectName ^ � � _ Well No VLl/L)` tY Date 4- f-5 - 7Y <br /> Protect No V / �0Personnel �n _ <br /> A�r1` f icrfr�� <br /> GAUGING DATA <br /> Water Level Measuring Method �i;��'ferC�_ r`c�0� Measuring Point Description <br /> Casing Total Req'd <br /> WELL Total Depth Depth to Water Water Column Multiplierfor Volume Purge Volume <br /> VOLUME (feet) (feet) — (feet) X Casing Diameter (gal) — (gal) <br /> CALCULATION <br /> — 3� <br /> G 026 44 1 4 � L �� dad <br /> � 06 4 <br /> PURGING DATA <br />' Purge Method �Q l:yV YC�{-a( Purge Depth _.S CC/tJ Purge Rate 6 <br /> Time <br /> Y Volume Purges(gal) -} " ;z L i o <br /> Q <br /> { C7 <br /> Temperature <br /> pH <br /> - Specific Conductivity(urnhos) i_ _�;�y� � <br /> - S !L7 �C�� �La r <br /> TMTurbtddyf Color r 'fir== �,.. b <br /> A M .Y. t� N)V <br /> --.�.y- <br /> '=CasingVol umesRemoved �= O <br /> Dewatered? L �v <br /> Comments/Observations <br /> SAMPLING DATA' Time Sampled `-L�D A Ya 7 p pprox Depth to Water During Sampling <br /> Comments <br /> volume Shipped Under Chain i <br /> Sample !Number ofContainer Filled of Custody at a°C A.aiysrs <br /> Number Containers `Type Preservative (mL or L Turbidity Coior �N Method a YComments <br /> r <br /> Total Purge Volume _ �Gf.�Cl�!'Z� Disposal/Containment Method <br /> atherConditions Y <br /> n <br /> odition of Well Box and Casing atTtme of Sampling <br /> gWell Head Conditions Requiring Correction(locks damaged casing or well box etc) �`-l6 <br /> Problems Encountered During Purging and Sampling <br /> Comments <br /> PM5PR0J TEMP FORMS PURGE 2096 <br />