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GROUNDWATER PURGE AND SAMPLE FORM <br /> Date 1iC� (0 <br /> Project Name XX D'"1_ __ Well Number Mw3 <br /> Project Number 5 E5 O 131 Personnel qah ti3nn1¢ o <br /> GAUGING DATA <br /> TA <br />' Water Level Measuring Method pro Measuring Point Descrioaon G C <br /> Casing Total Rea <br /> WELL Total Depth Depth to Water �I Water Column I Multiplier for Volume I Purge Volume <br /> VOLUME (feet) �� (feet) �� (feet) Casing Diameter (gal) �� (aail <br /> CALCULATION �J �� �J 2 4 s ► lJ <br /> 55 0 0 3 J4 0 "5 2 0 i 0161064 1 44 13.3 1 i l �o �� <br /> PURGING DATA <br />' Purge Method Purge Depth ,5crT ?q n Purge Rate <br /> 1' 051 io5 io5(p <br /> Time , <br /> Volume Purges (gal) U i3 C] , 1.-1 � � 0 <br /> f <br /> Temperature (°C) <br /> pH 1`6 5 ! '1 Q6'5 "19 I I <br /> Specific Conductivity (umhos) (9(0 5 9173 <br /> 12pq� q5(p i <br /> Trbidity/Color Il � �pI } °�( CiQ Ik �wG 't I y��ci <br /> Q <br /> u17::Odor ,JSv► <br /> Casing <br /> Volumes Removed I 3 1 <br />` Dewatered? I N I <br />' Comments Observations <br /> SAMPLING DATA Time Sampled 05 q Approx Dewh to Water During Samoiing 3� <br />' Comments <br /> volume Sh,00ea unser Crain of I ! <br /> Samoie fVurr>Der of Container 1=,lien I Cu5toav { Anaiyss y <br /> Numoer Cantamers Type Preservatwe fmtor l_7 Tura,aiN Coior l at a� rv'r�i 1 Metros I Comments <br /> 13 ow I[lav✓` I - I 9 <br /> .Total Purge Volume H U Disposal,'Containment Merhod en-s <br /> Weather Conditions C 1 ZCV7 <br /> Condition of Well Box and Casing at Time of Sampling CS <br /> Well Head Conditions Requiring Correction (locks damaged casing or well box etc ) r-J <br /> Problems Encountered During Purging and Sampling fJ <br /> i Comments <br /> OM4 vnpJ TMA c QRGE'234 <br />