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ImDate <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name Well Number <br /> roject Number .� Personnel <br />' GAUGING DATA <br /> Water Level Measuring Metho d 'e Measuring Point Description <br /> Casing Total Req d <br /> WELL Total Depth Depth to Water Water Column Multiplier for Volume ILPurge Volume <br />' VOLUME (test) (feet) _ l (feet) X Casing Diameter (gal) _ (gal) <br /> CALCULATION 2 4 6 <br /> �glvD '3SSr� 0161064 1 44 <br /> PURGING DATA <br /> 1 Purge Method � � „ Purge Depth G Purge Rate c <br /> � <br /> Time 3d <br />' Volume Purges (gal) <br /> Temperature (°C) yl. ,y r� Z �• 'z I <br /> pH <br /> Specific Conductivity(umhos) <br /> Turbidity/Color <br /> Odor I f�j Q LCA CO <br />' Casing Volumes Removed t Z <br /> Dewatered' <br /> 1 <br /> Comments / Observations <br /> 1 <br />' SAMPLING DATA Time Sampled O Approx Depth to Water During Sampling 4 <br /> Comments <br />' Volume <br /> shippea under ChaLn of Analysis <br /> Sample Number of Canta�ner Filed Color Custody Meu+od Comments <br /> NumCer Containers Type i Preservaitve fml_or L1 Turbidity at 4'C fYlW <br />' Total Purge Volume (' sG - Disposal/Containment Method <br /> eather Conditions <br /> Condition of Well Box and Casing at Time of Sampling L <br /> Well Head Conditions Requiring Correction (locks dams ed casing or well box etc ) <br /> Problems Enc un ed During Purging and Sampling <br /> Comments <br />' PMa PRoJ-,vP PURGE I29A <br />