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GROUNDWATER PURGE AND SAMPLE FORM Dae <br /> Protect dame: �c �cr �yG2 Well Number ki 1 <br /> r Protect Number <br /> a 2_ Personnel. G <br /> AUGING DATA <br /> Water Level Measuring Method r <br /> Measuring Point Description <br />' Total Depot Depth To Water Water Column~ Casing Total Req'd <br /> WELL (feet) (feet) Multiplier For <br /> VOLUME; (feet) Casing Diameter Volume Purge Volume <br /> CALCULATION X _ (gal) (gat) <br /> I . 7�' q 2 4 fi w <br /> P 0 i6 0 fi4 i y `• � 44 Z. <br /> URGING DATA 3 7- <br /> Purge Method �� _ — <br /> Purge Depth Purge Rate <br /> Time - <br /> - <br /> Volume Purged(gal)~` <br /> Temperature (°C)pH <br /> Specific Conductivity (gmhos) <br /> Turbidity/Color , . - [mw <br /> l�C <br /> Casing Volumes Removed - <br /> Dewatered7 <br /> Comments/Observations <br /> AMPLING DATA Time Sampled <br /> Comments , Approx Depth to Water During Sampling <br /> sarnpio fVurreer o! Cor Leiner Va4nw Flied Shpped tinder Cham at <br /> Number Conudnera Type <br /> Turbidity �,� Custody /t�� <br /> I+ at 4'C(YfN) AAaMod ��� <br /> natal Purge Volume <br /> I <br /> Ieather ConditionsDisposal/Containment Method ' <br /> nd:tion of Well Box and Casing at Time of Sampling <br /> Pead Conditions Requiring Correction (locks, damaged casing or well box etc ) — <br /> o ems Encountered During Purging and Sampling I-, <br /> mments L/ — <br />