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Date /�3 Z <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Protect Well Number z <br /> Protect Number• 8' Samplers L <br /> AUGING DATA <br /> Water Level Measuring Method .,�r�rf��..��� Measuring Pont Description 76 <br />' Casing Total Rev'd <br /> WELL Total Depth Depth to Water Water Column Multiplier for Casing Volume Purge <br /> (feet) {feet) (feet) X Diameter (gal) Volume (gal) <br /> VOLUME — _ <br /> 4 8 � ^ <br />' CALCULATION 3�, 5 r' o is o s4 t 44 <br /> PURGING DATA <br /> Purge Method; L&t _Purge Depth ,,fist — <br /> Purge Rate- <br /> Time / �QJ ,���► 1/ 1 / ��` <br />' "Volume Purged(gal) . ?j <br /> <Temperature °C ZC Cj / , G l 0 <br /> H <br /> p v} 6r� Cc <br /> 'Specific.Gonductiuit p�nfios} �;OC C6 <br /> hTurbidltyS C <br /> > oar <br /> Casmg vpldraes"Reri OV d 2, �(.o <br />' Dewatered? (YINY-- <br /> Comments/Observations <br /> Comments/Observations <br /> SAMPLING DATA / <br />' Time Sampled- �d Depth Sampled: 3� Approx. Well Recovery- <br /> Volume Shipped Under Analysis <br /> Sample Number of:Contarner < ' Filled Gtxain of Custody Method <br />' �lum6er Containers 'hype . 'Pfeservative r�orl� Turbidity Color at 40C(1llt�t} (method) Comments <br /> yo <br />' Total Purge Volume 7 D�sposaVConta�nment Method <br /> Weather Conditions d <br /> Condition of Well Box and Casing at Time of Sampling P99� <br /> Well Head Conditions Requiring Correction (locks, damaged casing or well box, etc). <br /> Problems encountered During Purging and Sampling tt/arx/ t� <br />' Comments <br />