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' GROUNDWATER PURGE AND SAMPLE FORM e <br /> LPrallect <br /> Name Cx�d Well No V� Date <br />' No S-/S�� �� • / 3y<� Personnel lat"'p-N <br />' GAUGING DATA <br /> Water Level Measuring Method /��i2F�r� l�Ry r- Measuring Point Description ``C — <br /> Casing Total Re <br /> WELL Total Depth Depth to Water Water Column Multipiierfar Volume Purge Volume <br /> VOLUME (feet} (feet) (feet) X Casing Diameter (gal) (gal) <br /> CALCULATION (� I 4 6 <br /> 0`-1'6 0 64 1 44 <br /> PURGING DATA <br /> Purge Method VAC��.y'1-). 'c.c�K Purge Depth SCrQ5!5-e/V Purge Rate <br /> /I23 <br /> Vofume Purges(gall, <br /> _t �3-2•.c7 � c7 <br /> I -Spec 1C Conductivity(ira os) I -7-7v 73"0 G� <br /> w Turrbiiddy/Color i.� �-� <br /> =CasingVolumesRemovedCr r- <br /> �;� <br /> isxx <br /> Comments/Observations Ogw <br /> SAMPLING DATA Time Sampled ;L.7 Approx Depth to Water During Sampling rr <br /> Comments <br /> Volume Shipped Under Chain <br /> Sample Number of Container Filled of Custody at 40C Analysis <br /> Number Cantamers Type Praservauve (mL or U Turbidity Color !TJ Method Comments <br /> CI 9 + � <br /> Te � <br /> talPurgeVolume , - y_bA��vhr5 __ Disposal/Containment aIL.S 7--0A-j-t- <br /> eatherConditions 5 uN <br /> I Condition of Weil Box and Casing at Time of Sampling <br /> Well Head Conditions Requiring Correction(locks,damed casing orwell box,etc) 41/ <br /> Problems Encquntered During Purging and Sampling , fu <br /> Comments <br /> PSN3.Pii0U.TpdPFORbtS.PUFGE1096 <br />