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1 <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name C XO IN Well No �/%�'✓ ¢ Date <br /> Project No Personnel %8v4iN <br /> GAUGING DATA <br /> Water Level Measuring Method YKIT FAr-,�5 Measuring Point Descnpticn ACX' <br /> Casing Total Req`d <br /> WELL Total Depth Depth to Water Water Column MulUplierfor Volume ( Purge Volume <br /> VOLUME (feet) (feet) (feet) X Casing Diameter (gal) (gal) <br /> CALCULATION ,ee — 2 I ,C 16 <br /> 1 71 41 0 1610 64 11 44 <br /> PURGING DATA <br /> Purge Method V�C�-t c �YY?_ �c.c�K Purge Deptf� sC�E�/V Purge Rate � (4-2 �-1 <br /> Tune _ _' -2— �2i i l2c�" l4 r7 <br /> Volume Purges(gal) `='•- O 1 -,7 <br /> Spe_ctfecConductivtty(umhos}mow �C> <br /> �Ttibfdd}i/Csolor,' <br /> Odor <br /> u`^4•'°'.=>�' R^.—`k. Jt'C-y".yfn5�Fe tw�V`F" <br /> CasingVo[umesFtemovFes / Al <br /> Comments/Observations <br /> SAMPLING DATA Time Sampled Approx Depth to Water During Sampling � <br /> Comments <br /> Vatume Shipped Under Chan <br /> Sample Number of Container Felted of Custody at a°C Analysis <br /> Number Containers Type Preservadve {mL or LI Turbidity Color /N1 Method comments <br /> ffi <br /> W I VOA ICL I rnr_ 1� Cuo-r 9 rm� <br /> tal P u rge Vol ume oma''—� bP�Ns, Disposal/ContainmentMethod TFArLEF 7-0 t-c_ <br /> �o <br /> eather Conditions c" <br /> Condition of Well Box and Casing at i e of Sampling <br /> 0 Le— <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwell box etc) <br /> Problems Encountered During Purging and Sampling <br /> Comments <br /> PM&PROLTEMPFOMASPU GE1096 <br />