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Date !Z 31 Z <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Protect.r Well Number �`� Z <br /> Protect Number � 94T z`� Samplers G <br /> AUGING DATA <br /> Water Level Measuring Methods easunng Point Description <br /> Total Depth Depth to Water Wafer Column Multiplier for Casing Casing Total Req'd <br /> WELL (feet) (feet) (feet) Diameter Volume Purge <br /> VOLUME _ (gal) Volume (gal) <br /> CALCULATION q 7 — x 2 6 <br /> -7�' ! 016 064 144 <br /> PURGING DATA <br />' Purge Method %'� �`,�'� Purge Depth Purge Rate <br /> Time <br /> k Volume Purged(gal) <br /> Temperature(°C) <br /> pH <br /> Speclfic Conrtucgi ity (prnhas) q00 S00 90 <br /> �Ttlrbidity 4 1 Color: A /7 r� L✓ P� C t,e Cz,c <br /> 1 } 3 S <br /> k asing-Vo{iumes Reniaued°< YC <br />' ~Dewatered?&IN) nh nJ <br /> Comments/Observations <br /> SAMPLING DATA <br />' Time Sampled _ f f Z� Depth Sampled Ga �Y� Approx. Well Recovery <br /> Volume Shipped Under Analysis <br /> ~Sample Number of Container Filled Chain of Custody ,*tCltaettiod: <br />' +Number Containers Type Preservative Qrl) Turbidity Color at 4aC(YIN) (method) Comments <br /> �tvZ �sw -H G -es <br /> i <br /> 1 <br /> 1 Total Purge Volume ��v-4• Disposal/Containment Method ^— <br /> Weather Conditions <br /> Condition of Well Box and Casing at Time of Sampling ErcyVetcl, l' a' <br /> Well Head Conditions Requiring Correction (locks, damaged casing or well box, etc) 1` <br /> Problems encountered During Purging and Sampling Waa--r_- <br /> Comments <br />