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' G ROUNDWATER PURGE AND SAMPLE FORM Date <br /> Project. rX1CMWell Number: 11Z CJ <br />' Project Number. -7 Samplers. <br /> AUGING DATA <br /> JL <br /> Water Level Measuring Method Measuring Point Description� <br />' Total Depth "Depthater Water ColuIplier for Casing Casing Tata! Req'd <br /> WELL (feet) (feet) DiameterVolume Purge <br /> VOLUME _ _ (gal) Volume (gal) <br /> CALCULATION fJ ✓ . 4 6 z064 1-44 <br />' PURGING DATA <br /> Purge Method C'un Py/�1 Purge Depth- *±f_ Purge Rate <br /> V <br /> ime hI! �� �� Z //� !/3olume Purged(gal) <br /> Temperature-(°C) }y Zl <br /> pH <br />' Specific.ConductiVity-41m fo (;6 �100 <br /> Turbidity <br /> 0 <br /> [ L <br /> {" M C G t_R r •_e2 C=am <br /> GasTngVolunie��?emi�vec€�;,,�; � . <br />' Dewatered? ('bN) - <br /> Comments/Observations <br /> SAMPLING DATA <br /> Time Sampled: //Ysr Depth Sampled: Approx Well Recovery- <br /> VolumeShipped llrider Analysis <br /> Sample Numbernt Containkn n filled Chain of Ctistody Method <br /> Number Containers' •Yype Preservative r I) Turbiidityd Color at 4'C jyIN) trnethod) Comments <br /> 3 t�oa. Ia C I f+Qtc� 11� Y-eS 77P465TKYa <br /> Total Purge Volume r/�1 _ DisposaltContainment Method <br /> Weather Conditions' d2 I <br /> Condition of Well Box and Casing at Time of Sampling SKQ <br /> Well Head Conditions Requiring Correction (locks,damaged casing or well box, etc)fid C— ! T <br /> Problems encountered During Purging and Sampling wa�oAr,, <br /> Comments xlerw <br />