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1. GROUNDWATER PURGE AND SAMPLE FORM <br /> f Protect Name _ )ea1__ _ Well No _SIr+_Z Date <br /> ProtectNo 55153R/47_ ^, Personnel --a G.: ++ a A O <br /> GAUGING DATA <br /> Water Level Measuring Method letr-�caP_a 6�_ Measuring Point Description —1 e <br /> Casing Total Req'd <br /> WELL Total Depth Depth to Water Water Column Muttiplierfor Volume Purge Volume <br /> VOLUME (feet) (feet) (feet) X Casing Diameter (gal) (gal) <br /> CALCULATION � _ <br />' 2 4 1 6 <br /> H 4 x-12 23 -12 zo., d 0 16 0 64 144 13 3 1 9 .q 4V <br />' PURGING DATA <br /> Purge Method VCvCw(n_TrVC« Purge Depth Sce-g Purge Rate 3 -351py—i <br /> 12 <br />' Volume Purges(gal) `'_ 3 G.5 o <br /> Temperature(°C) w-u � <br /> •,,Nk � 2 1 Cl I I q �o, U <br /> PH <br /> O 1'1 <br /> �.! .'�" J <br /> Specific Conductivity(umhos)-;��`� g 13 7 Q% y q 5 G <br /> w <br /> + St 1Ta{ c......r N rel r\1 �l d � � t <br /> Turbidity/Color �, 'w 1 '�' }. <br /> Odor wrNi <br /> ay <br /> a ly ^ rt!s"angi-�r7 <br /> i <br /> a CasingVottimesRemoved,.f 0 Z 3 <br /> Dewateredo <br /> -nom <br />' Comments/Observations <br />' SAMPLING DATA 5 0 <br /> Time Sampled 12., Approx Depth to Water During Sampling 110 <br />' Comments <br /> Sample Number of Container Volume Shipped under Chain Filled Anal <br /> Filled of Custody at 40C y <br /> Number Containers Type Preservative mL or L TurtWity Color /N Method Comments _ <br />' �L}r -TPH- <br /> Z V 6�5 Iii I L{Qr..�r Mai I'A'. [? <br /> Votal Purge Volume L D DisposaVContainment Method t ,-- <br /> Weather Conditions u <br /> Condition of Well Box and Casing at of Sampling <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwell box,etc ) <br />' Problems Encountered During Purging and Sampling tJ <br /> Comments <br /> 0*15 PRCVTEMP POOP S oSiRCCil)c+ <br />