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GROUNDWATER PURGE AND SAMPLE FORM <br /> Date <br /> Prolect:a@t 9",eJ04Y — Well Number: <br /> Project Number:QW2,2 q _ Samplers- At, � – <br /> GAUGING DATA <br /> Water Level Measunng Methodz measuring Point Description 1::�2 (-2- <br /> Casing <br /> Casing Total Req'd <br /> WELL Total Depth Depth to4WaterWater Column Multiplier for Casing Volume Purge <br /> (feet) (fee (feet) X Diameter (gal) Volume (gal) <br /> VOLUME _..CALCULATIONq � 2 4J'� 97 /. 016 64 1.44 <br />' PURGING DATA <br /> Purge Method, Purge DepthZkoPurge Rate <br />' Time q,?- <br /> Volume Purged(gal) � �c <br /> n � <br /> Temperature(°C) — Z r a Z <br /> pFf <br />' Specific o <br /> ,Ttlrtaidlty'Y!} j' r3 M <br /> AJO <br /> Casing Vo[uRY <br /> r <br /> Dewatered'?{Y11\t) <br /> Comments/Observations <br /> 1 <br /> SAMPLING DATA <br /> Time Sampled: Depth Sampled-D-�� Approx. Wel! Recovery <br /> n Volume Snipped Under Analysis <br />' Sample Number ofDontainer , Pilled Chain of GUstody Method <br /> Number Container Type„ - Preservative {tnl orqTurbidity Calor at 4'0(YIN) ttnethod) Comments <br /> 1 3 <br />' Total Purge Volume DisposauContainment Method <br /> Weather Conditions <br /> Condition of Well Box and Casing at Time of Sampling <br /> Well Head Conditions Requiring Correction (locks,damaged casing or well box, etc <br /> Problems encountered During Purging and Sampling <br /> Comments <br />