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GROUNDWATER PURGE AND SAMPLE FORM Date —1.11019(c <br /> Project Name _ XX 0r1 Well Number M� 1 <br /> roject NumberPersonnel galTh ti3ortt¢ I�o <br /> GAUGING DATA <br />' Water Level Measuring Method Pro Measuring Point Descriction G C <br /> Casing Total Req <br /> WELL Total Depth I Depth to Water �� Water Column I Multiplier far Volume 11 <br /> Purge Voiume <br />' VOLUME (feet) �� (feet) �1 (feet) �� Casing Diameter (gal) (gall <br /> CALCULATION 2 I ® I 6 I �J <br /> 5y . 25 331 I ',o �1 a161064 ' 144 ' 13 � o I� 3q 3a <br /> PURGING DATA <br />' Purge Method f` Purge Depth Purge Rate 3 a5 9PY-1 <br /> Time <br /> 09 15 I off►$ 0 57,z 09 15 <br />' Volume Purges (gal) I O I 13 26 13q 5 1 <br /> Temperature (°C) I j 2 -40 -- 120 1 205 <br /> Specific Conductivity (umhos) I (3 35 j 52 <br /> turbidity/Color <br /> t odor <br /> Casing Volumes Removed I 0 I I <br />' Dewatered'? N N { I <br /> Comments Observations <br /> SAMPLING DATA Time Sampled Approx Deoth to Water During Samoling 3(0 <br /> Comments <br />' Volume Snippe+a unser Cnain of ` <br /> Sample NurT>Der of Conta11 <br /> iner I Riety Custoay j Anatys�s <br /> NurnCer Containers Type k Preservative Turnca ty I GO1pf I Me[noc I Comments <br /> rmLor Ll at s�[Y Nt <br /> IMw I I a 1I Hc) iia ILIS of VA-21— <br /> I F 9 I <br /> W <br /> tal Purge Volume 39 S Disposal"Containment Method r—is <br /> eather Conditions <br /> Conctltton of Well Box and Casing at Time of Sampling <br /> Well Head Conditions Requiring Correction (locks damaged casing or Weil box etc ) � <br /> Prootems Encountered During Purging and Sampling f�1 <br /> Comments <br /> _.,.=par 7,"P OURGc'23.1 <br />