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GROUNDWATER PURGE ANODate s9y <br /> —qAMPLE FORM -- <br /> Protect Name Q 7 e-,�� _ Well Number -_ W <br /> Protect NumberPersonnel <br /> AUGING DATA <br /> Watt r 1_i_Vef fvleasurrrrq MCtfiod TT —�� <br /> Measuring Point Ocscr4piron <br /> Totdt Depth <br /> Depth 7o Water Water Column Multiplier For Casing Total I3eq d <br /> WELL (foot) (foot) (feet) Casing Diamoter Volume Purge Volume <br /> VOLUME ...� _ _ (gal) (gal) <br /> CALCULATION X 2 4 6 <br /> L 016 064 1 1 44 z L2 <br /> PURGING DATA <br /> Purge Method crii�Ucir.// <br /> Purge Depth,=;jj: y� Purge Rate <br /> Volume gal#A <br /> 3~ <br /> s�ctt;tr.CandtictiultYA�s�tl�osD. ✓~� 2w <br /> Gtadjf -Y <br /> YkY a4 S-t;v <br /> i <br /> mments/Oti servatio ns <br /> F <br /> PLI NG DATA <br /> Time Sampled. Approx. Depth to Water During Sampling <br /> Comments- <br /> }, x2`p�!] .G}v <br /> R }+rx .,k` <br /> s4i� tC.$- '`'� w ' . t".tisTgaCsvo�,ra . <br /> %` �-. ^oa a+Inr ,x s rTG +7.u �Jc� �xy//Y/t���s'gy'0.c,.'3 <br /> Y 3.4..a �vv^t^'YSC � �•"�I s4*�'[1 .Yv'� �`~� �M-.[�j�� +.. <br /> � G <br /> I Purge Volume- �• Qim <br /> sposal/Containent Method: <br />�ther Conditions: r <br /> n of Well Box and Casing at Tune of Sarnpling- <br /> ad Conditions Requinng Comedian(locks,damaged casing or well box.eta): <br /> Encountered Dunng Purging and S"Iing• <br /> mments- �� <br />