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GROUNDWATER PURGE AND SAMPLE FORM <br />' Project Name xorl _ Well No ��_ Date 11.1,4 1 4&_ <br /> ProtectNo 5 15 3,R _ Personnel <br />' GAUGING DATA <br /> Water Level Measuring Method M��-'11�0'cer 1-o 6e Measuring Point Descnption _ -0 G <br /> Casing Total 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 i� 2 4 6 <br />' y3 11 22 05 tZ 3 $ <br /> t 0 16 0 64 1 44 3 f o I <br /> PURGING DATA <br /> Purge Method C C. Vr1+ -17-V64 Purge Depth 5cr¢a-) Purge Rate 3 3 q?rn <br /> Time":-� <br /> r v � 11 3CJ it v 11 SI <br /> Volume Purges(gal},- <br />' N (J 5 1 v <br /> h .,� ..�.Ax ♦ �n l.y� <br /> Temperature(°C} 19 `i 101 5 <br /> it <br /> , t7 �S Si 1 0 S 10 <br /> a 5pecrfic Conductivity(utnhos}� r� Z , <br /> �Er r _� 4l Q1 8q2 gq �Li <br /> �Turbldrry/Color, <br /> �--Odor���•� �a;� -;x-��= s�"� t� � f ,� r <br />' M Casing Volurmes l=temoved 1 2 3 <br /> Dewatered? N <br />' Comments/Observations <br />' SAMPLING DATA Time Sampled I1 <br /> p K"i Approx Depth to Water During Sampling <br />' Comments <br /> Sample Number of Container Volume Shipped Under Cham <br /> Filled of Custody at 4°C Analysis <br /> Number Containers Type ?reservaGve ml,or L Turbidity Color /N Method Comments <br />' 1 v o oL5 F-IC t t-1 O r,.,4 r•��wr. t} n �H- <br /> otalPurgeVolume 1 0 Disposal/ContainmentMethod Jr rN^i <br /> Weather Conditions <br /> Condition of Well Box and Casing at Tim6 of Sampling QV <br /> - <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwell box,etc ) <br />' Problems Encountered During Purging and Sampling tV <br /> Comments <br /> PVI;Pg0J TEK40 FOPMC P11RCa,noA <br />