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GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name _ Ckxo 1 Well No —MAS Date4 1Iq"1 <br />' Project No Jt~ 15 p 131. ! 3 O p Personnel <br /> GAUGING DATA <br /> Water Level Measuring Method q PrDk> Measuring Point Description d C <br />' WELL Total Depth Depth to Water Water Column Multtplterfor Castng Total Req'd <br /> VOLUME (feet) _ (feet) _ (feet} Casing Diameter Volume Purge Volume <br /> CALCULATION X (gal) {gal} <br /> 30. C�Z 2 4 6 <br /> 0 i6 0 64 1 44 {$•B5 5G,5y <br /> PURGING DATA <br /> Purge Method VQS Lk)e" Tr'U k 4 Purge Depth 6 Z_qz:1 Purge Rate ( 3 <br /> Y tiA a r <br /> Y Time <br />' Mtit 5 11: 11.11 ( .yy <br /> Volume Purges{gal) v . 3% 5G.5 <br />' j Temperature(°C).,. . <br /> pH'- <br /> -:-Specific Conductivity(umbos) I y 9-1 I H(b 3 144 9 Se J y $7- <br /> Turbidrty/Color y t°'^r �-. !u-"'' sOw lw. <br /> Odor <br /> Casing Volumes Removed t 2 <br />' Dewatered?- <br /> - , N <br /> CommentslObservattons <br />' SAMPLING DATA Time Sampled l 1 -'4 g <br /> P Approx Depth to Water During Sampling 3 5 <br /> Comments <br />' Sample Number of Container VolumeedShipped Under Cham <br /> Number Containers Type Preservative Pilled Turbid[ Color of Custody at 4°C Analysis <br /> mL or i tY IN Method Comments <br /> M 3 <br /> V= HO L aw <br /> Total Purge Volume 5C0. S <br /> Disposal/ContainmentMethod ±nzij 1t- +tJ <br /> eather Conditions <br /> anditionofwell Boxand Casing atTime f ampling Q <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwefl box,etc ) <br /> Problems Encountered During Purging and Sampling <br /> Comments <br />' PMS"IC4TEMP PORMS PUAGE1096 <br />