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i <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Protect Name _ C�XbN Well No — P I _ — Date 5— —6? <br /> Protect Na S/S �� �-� /3C>Q Personnel <br /> GAUGING DATA <br /> t Water Level Measuring Method 'LA17- <br /> pgo& Measuring Point Description `rL <br /> WELL Total Depth Depth to Water Water Column Multipiterfor Casing TotalReWd <br /> Volume I Purge Volume <br /> t VOLUME {feet) (feet) _ (feet) Casing Diameter {gal) <br /> CALCULATION , <br /> # 0 16 10 64 11 44 <br /> PURGING DATA <br />' Purge Method Ff Cm c c� Purge Depth SCR-je- IV - <br /> 9 P Purge Rate _�' ✓l <br /> Trine=_ - 4 - '-- IZ`(�J k2--A t 1ZH I I <br />' Volume Purges(gal) <br /> Temperature CpH- <br /> ) v: i 4�� �7 -'� �Q • ! <br /> ` v <br /> oil -Specific Conductivity(umhos)_ q 11 1r 82— t-A I- <br /> Turfiidrty/Color <br /> - - �- UtJ <br />' -4 <br /> Odor,-, <br /> Casing - umes Removed <br /> `Dewatered7 <br /> Comments/Observations <br /> SAMPLING DATA Time Sampled 12 52 Approx Depth to Water During Sampling <br /> Comments <br />' Volume Shipped under Chain <br /> Sample Number of ConiamerFilled of Custody al a°C Analysis <br /> Number Containers Typa Preservative mL or Ll Turbidity Color IN Method Comments <br /> IVDA, Hr-C- I n)L. g frTr� <br /> I71I I I <br /> 'al Purge Volume 4 &t1Lt-4)lv5 Disposal/ContainmentMethod TSA UEg 7- RL AkLC1 <br /> therConditions �VY}Yl <br /> ndltion of Well Box and Casing at Time of Sampling <br /> Well Head Conditions Requiring Correction(locks damage casing or well box,etc) <br /> Problems Encountered During Purging and Sampling ts <br /> Comments <br />'PN-5 PROJ TrzvP toRM$PURG't1C 5 <br />