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M GROUNDWATER PURGE AND <br /> _ SAMPLE FORM <br /> Prclect Name C'�xeN Well Na /1 U•n <br /> Date- S- Z_ --12 <br /> J- P,otect INo Personnel <br /> GAUGING DATA <br /> Water Level Measuring Method LlT iRF'Qc 260 ;E- Measuring Point Descriotion -7-CC <br /> WELL Total Depth Depth to Water I I Water Column Multiplier or Casing I T o,al Req'd <br /> feet Volume Purge Volume <br />' VOLUME (feet) ..r (feet) (feet) Casing Diameter (gal) (gal) <br /> CALCULATION X — <br /> 3D i� I c 1 6 '1-3 <br /> ce �I 0 161 Q 64 1 1 44 <br />' PURGING DATA <br /> tPurge Method VFi CI cuy-4 i��-c�_�_ Purge Depth Purge Rate 14 <br /> TimeILD 14 <br /> _ v <br />' Volume Purges(gal) <br /> Temperature(°q) <br /> 3-31 'z 3 34 <br /> -5pecrfic Conductivity,( <br /> urbrdr /Color . �;.r� ",'_ Cwt.a `Ji-�s <br /> _ �! =; w,.�~ _ to � 6 <br /> -_odor <br /> �J"he•�__.f—ice F" �\ \ I r <br /> r Ca— 1 � J a r ` 4 •tU ✓ <br /> CasmgVolumesRemoved:-r <br /> Dewatered'?'$---Z' 7 <br /> Comments/Observations <br /> 5 <br /> SAMPLING DATA Time Sampled S 0+ <br /> P l0 Approx Depth to Water During Sampling 14 <br /> Comments <br /> t <br /> Volume Shipped Under Cham <br /> IV <br /> Sample Number rs Container Filled of Custody at 4'C Analysis — <br /> Number Containers Typo Preservative (mL or L) Turbidity Color (YIN} Method Comments <br /> WA I Hcc I rnL I <br /> low ! g VEJ t <br /> 1 I I I <br /> otalPurgeVolume azj 6Rt_c_ )NS Disposal/ContainmentMethod �jcE Tib RUM-t_c- ` <br /> therConditions Su -- <br /> rtron of Well Boxand Casing atTime of Sampling v <br /> ellHead Conditions Requiring Correction(locks damaged casing orwell box,etc) <br /> ems Encountered During Purging and Sampling <br /> Comments <br /> PRQ1•TE&AP FOPUS PURGEIC95 <br />