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GROUNDWATER PURGE AND SAMPLE FORM <br />' Project Name t=xxcwl _ _ Weil No 5W I Date t! <br /> Project No 5 t5 3 QQ Z Personnel Com+ tz 11 <br />' GAUGING DATA <br /> Water Level Measuring Method =rr�'-•'olca R-obe _ Measuring Point Description —i C <br />' Casing Total Aeq'd <br /> WELL Total Depth Depth to Water Water Column Multipllerfor Volume Purge Volume <br /> VOLUME (feet) _ (feet) (feet) X Casing Diameter (gal) _ (gal) <br />' CALCULATION 2 4 6 <br /> z 3 z�I z4 f y B �(,� 0 1610 64 i 44 $q <br />' PURGING DATA <br /> Purge Method Voacuyr1 `rNCK Purge Depth .Screon Purge Rate 3.0 <br /> Time <br /> 13 IL 13 13 13 tH 13 � I <br /> Volume Purges:(gal) �- � <br /> Temperature( C) <br /> PH'^ 3 1 4S ! 00 I 1 <br /> Specific Conductivity(umhos)v-€-"3` 5 3s 3 $ 1-:K0 <br /> w hi onl��•^ rr, ++rr• + <br /> .-Turbidt y/Color 9 <br /> t"J rJ N <br /> k lCasmg Volumes-Removed <br /> ,w > <br /> _Dewatered? '�r - :�1°��.� r1i N <br />' Comments/Observations <br />' SAMPLING DATA <br /> Time Sampled 13 1% Approx Depth to Water During Sampling <br />' Comments <br /> Volume Shipped Under Chain <br /> Sample Number of Container Filled of Custody at 010 Analysis <br />' Number Containers Type Preservative mL or L Turbidity Color M Method Comments <br /> S�•! 1 yo ins HC I yOr,.,t emciiin 6eew <br /> flol 'purgeaVolumllBe Dlsposal/ContainmentMethodWeatherondttlons oU <br /> ConditionofWeoxand Casing dt Time ofSampling OK <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwell box,etc ) <br />' Problems Encountered During Purging and Sampling <br /> Comments <br /> pV5 Pq,^„I TEMD F04n,v PilRrc yy; <br />