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Date- <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name �`/Z Well Number <br /> Project Number u U5 Personnel <br /> GAUGING DATA <br /> Water Level Measuring Method _ Mm(- /o(K _ Measuring Point Description 7�C <br /> Casing Total Req'd <br /> ;Total Depth M(teet) <br /> Water Column Multiplier For Volume Purge Volume <br /> WELLeet) (feet) Casing Diameter (gal) (gal) <br /> VOLUME +� K <br /> CALCULATION 2 1 4 6(��� �i6 064 144 <br /> PURGING DATA <br />` Purge Method � `rwt,(Q -Cd/A(G -re/ l rt Purge Depth �VeV smo _ Purge Rate <br /> Time <br /> vo4ume Puirp6d [gaff <br /> Y 4 v Y • <br /> speak CCiF1C ucfiVIIy( mf6s) <br /> Turbi*J#60[01 <br /> orA r <br /> Casmg tfi kones Removed- <br /> Comments/Observations t riaf j,!�. €{ ,{��t,L, r G'�C�t e 7 f v <br /> ' SAMPLING DATA Time Sampled /S t3 Approx Depth to Water During Sampling <br /> Comments a t e <br /> �vppect Under Mwn of <br /> $arr�i�e 19=m eruE Con#atner Voti$rt-FMed Custody Asiatysts <br /> Idua�t r Cantwners ' Type Pre malr a Jmt or t� 'rwbtdity Cour at 4`C(WN} ly- <br /> >4teit�od C�tRcveT s <br /> J� 1 �C .x <br /> u <br /> total Purge Volume a Disposal/Containment Method 3�` 1 `'�k MIM <br /> Weather Conditions <br /> edition of Well Box and Casing J Time of Sampling +}� <br /> II Head Conditions Requiring Correction (locks,damaged casing or well box, etc) / <br /> Problems Encountered During Purging and Sampling r)_a k4 <br /> Comments �'� <br />