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GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name xan _ Well No W I Date 11 <br /> Project No 5115 3'RQ Z _ _ _ Personnel --A3-- 0 <br /> GAUGING DATA <br /> Water Level Measuring Method te r ra R"a�e. Measuring Point Description 71-pc: <br /> Casing Tota!Req'd <br /> WELL Total Depth Depth to Water Water Column Multiplierfor Volume Purge Volume <br /> VOLUME (feet) (feet) (feet) X Casing Diameter (gal) (gal) <br />' CALCULATION 2 4 6 <br /> 22 146 2W G <br /> 01 <br /> 16 0 64 144 5'�g y7 33 <br /> PURGING DATA <br /> Purge Method VckeuVr't T-VCK T� Purge Depth Scr¢o Purge Rate 1 Py"n <br /> Time 11 5 <br /> It 51 11 5CJ 12 o I <br /> t �1^ <br /> Volume Purges(gal) " 37— <br /> mr .t s <br />' �. T ox t' <br /> Teperature(°C) � "' <br /> � x �� I $. S iq 3 iq 3 <br /> 1E6 Oil qJQ3 <br /> specific Conducttvtty(umhos) "•}` q3 Z cizq 4 3 92�{ <br /> fi n <br /> rbi i.r <br /> Tulh !Color <br /> Casing Volumes Removed <br /> Dewatered? , ` �- 1N4 <br />' Comments/Observations <br />' SAMPLING DATA <br /> Time Sampled Approx Depth to Water During Sampling <br />' Comments <br /> Volume Shipped Under Chain <br /> Sample Number of Container Filled of Custody at a°C Analysis <br /> Number Containers Type Preservative mL or L Turbidity Color /N Method Comments <br /> voo�.5 NCI 40,,,,1 i o.r <br /> otal Purge Volume Disposal/ContainmentMethod ,��1vr '+o Pori c <br /> Weather Conditions C bV <br /> Condition of Well Box and Casing at Time of Sampling QK <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwell box,etc) <br />' Problems Encountered During Purging and Sampling ..1 <br /> Comments <br /> V V9 PRW T-CVP PontV¢pi1qCC,,yW <br />