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En - <br /> GROUNDWATER PURGE AND SAMPLE FORM Date Sir Yf-0 <br /> Protect Name ' a��7- Well Number <br /> Protect Number Personnel J� <br /> GAUGING DATA <br /> Water Level Measuring Method Measuring Point Description ro <br /> Casing Total Regd <br /> Total Depth Depth To Water Water Column Multiplier For Volume Purge Volume <br /> WELL (feet) (feet) (feet) Casing Diameter (gal) (gal) <br /> VOLUME K �- <br /> CALCULATION <br /> 1 064 144 <br /> PURGING DATA <br /> Purge Method LAvrewe 1464-k- Purge Depth Purge Rate WI 41(n <br /> Time'. 4 t.! <br /> 'Volume Plltdo Gal) . V <br /> T@t31)?ei atilt (�C v Y <br /> P14 ` <br /> }; E:{f6i;C.iv�3L�t7CttVlt:�.�Li�3��RS� <br /> Tuttiid <br /> y <br /> zi��5frig 1lodr3rf�E�'S 1�8t13CZtfF:Cl <br /> tbewatered?- 1E <br /> Comments/Observations _ e hol�� PLIN <br /> �AMPLING DATA Time Sampled / Approx Depth to Water During Sampling — <br /> Comments �- <br /> . .,. - sh,pgec�tcK�rtor ?. <br /> ;Ne >t unshei sal coniwner Vortsne FfUd 4 Custody Anaty,,os <br /> gon�ners <br /> Type Presacvanve tPAQrq Tw tlftry , fo{at ~ era'C Y1nV Meaim, renis, <br /> r-.- <br /> al Purge Volume _ l r G,.� �G��� _ _.—_— Disposal/Containment Method s <br /> ather Conditions t� <br /> ion or Well Box and Cai g at Time of Sampling k— �_�---- <br /> ead Conditions Requiring Correction (locks, damaged casing or well box,etc) <br /> leets Encountered During Purging and Sampling <br /> frments ' <br /> L <br />