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1 <br /> tGROUNDWATER PURGE AND SAMPLE FORM <br /> ProlectName CXb Well No �W ' Date <br />' PrciectNo S/S3� `=� , r 3C��� Personnel <br />' GAUGING DATA <br /> Water Level Measuring Methcdf�iROnr= Measunrzg Point Description �C <br />' I <br /> "CasingTotal Req'd <br /> WEIL Total Depth Depth to Water WaterColumn Multiplierfor rgeVolume <br /> VOLUME (feet} (feet} (feet} XCasing Diameter (gal) <br /> CALCULATION ~ <br /> — 2 <br /> 01SIQ 411 44 <br />' PURGING DATA <br /> Purge Method /iC." c.cr' Purge Depth SC195-6/"J Purge Rate <br /> 516- 9 <br /> Volume Purges(g __ _ v �� 1 ,-2 <br /> Temperature -2/ I �C>,�' U- <br />' Specific Conductivity(umbos) CSS <br /> Y� <br /> _- -�YT 12�� <br /> iic.Lurbidity/Color „A: W -t- r a <br /> -Odo <br /> Cas_mg U!le f <br /> Comments/Observations <br /> SAMPLING DATA Time Sampled �o�-�sApprox Depth to Water During Sampling :2�;I- <br /> Comments <br /> I Sample Number of ContaiFlied of Custody at a°C Analysis <br /> Vvtume Shipped Under Chain _ <br /> Number Containers Type Preservative mL or Ll Turbidity Calor ltVl Method Comments <br /> I /)'f kz11 n I V DA h CL m L i rI CC. g tr r <br /> Wtal P u rge Vol urn e DtsposaVCantarnmentMethcd �_ 1 AtC=E(� T`7r.t, �_ <br /> eather Conditions u n/N tj <br /> Condition of Welt Box and Casing at Time of Sampling Q 51 <br /> Well Head Conditions Requiring Correction(locks,dam <br /> As�d casing orwetl box,etc ) <br /> Problems Encountered During Purging and Sampling 1j <br /> Comments <br /> PW PR=TVAP FORMS.PVF GE1096 <br />