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En <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> ProlectName x.o^ _ _ Well No `r/\\41 „ Date 1 L1 9i <br /> Protect No 51 013-1 13 U o Personnel 1 , <br /> GAUGING DATA <br /> Water Level Measuring Method Ta±zn c � Prod'? Measuring Point Description I O C_ <br /> WELL Total Depth Depth to Water Water Column Multiplterfor Casing Total Req`d <br />' Volume Purge Volume <br /> VOLUME (feet) (feet) (feet) X Casing Diameter (gar) (gal) <br /> CALCULATION 2 4 6 <br /> 5q 1Z 32 I U 21 �Z 016 064 144 11 �� S3 0 � <br /> PURGING DATA <br /> Purge Method Vac r, C k Purge Depth 6Cle<,� Purge Rate Urn <br /> ;Tune,, <br /> Volume Purges(gal)LL_ }+ �� O <br /> .� <br /> =Temperature(° <br /> SpFecrfic Conductty ry(urtihos)r ! O—1 LI 1 l 4 g 1119 t <br /> rTurbidity/Color�'"v-� <br /> Cleo <br /> -Odor_ <br /> -fdastnq Volumes Removed <br />' Dewatered� <br />' Comments/Observations <br />' SAMPLINGDATA Time Sampled 0'6 3a <br /> P Approx Depth to Water During Sampling 38 <br /> Comments <br />' Volu <br /> Sample Number of Container me Shipped Under ChainFilled of Custody at 40C Analysis <br /> Number Containers Type Preservative mL or L Turbidity Color /N Method Comments <br /> T7'N' <br /> MW1 1C 1 Flo rnl <br />' tal Purge Volume 53 Drs osaVContalnmentMeihod �`F�f! 'fo <br /> P ar <br /> atherConditions c o ��I -- ' <br />' nditlonofWellBoxandCasingatTimeofSampling D K <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwell box,etc) <br /> Problems Encountered During Purging and Sampling <br /> Comments <br />' PM5 PRO,1 TEMP FORMS PURGE1096 <br />