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' GR Date 5 <br /> GROUNDWATER PURGE AND SAMPLE FORM �� y�' <br /> Protect Name actt(Z Well Number <br /> Protect Number _ �'s 3 y z o2 3 Personnel <br /> GAUGING DATA <br /> Water Level Measuring Method io tib <br /> Measuring Point Description <br />' <br /> WELL Total Depth Depth To Water Water Column Multiplier For Casing Total Req'd <br /> ( ) (feet)(feet) feet Volue Purge Volume <br /> VOLUME ) Casing Diameter m <br /> CALCULATION OMNI — X (gat) (gal) <br /> STP 20 G Q2 4 6 <br /> 16 064 144 <br /> PURGING DATA <br />' Purge Method 1-4w,TAIJ U J L 7> t vt purge Depth i,.l 0 <br /> _ Purge Rate <br /> Time <br /> S <br /> Volume Ptfrged(garl)'J <br /> emperature <br /> Speddic Conductivity(Amho�) <br /> Turbidity f Cruor <br /> Casing VOlemeS Removed' <br /> --0 <br /> Dewatered? �1I <br /> IComments/Observations A/0 y K- <br /> SAMPLING DATA Time Sampled ApP r <br /> � ox Depth to Water During Sampling <br /> Comments ,� <br /> S=Pfe Number of Container Va Ui ne Filled PA th 9r Gtt&lp 4t <br /> N=ber Containers `type PreservaUve fmlorl} Turbiddy �oiarrr Custody! Analylis <br /> ar4`C(WN� iuethod' ``Cv+rxrterits <br /> (140 tn <br /> L <br /> Total Purge Volume Disposal/Containment Method S r`- <br /> Weather Conditions <br /> nditlon of Well Sox and Casing r Time of Sampling L <br /> It Head Conditions Requiring Correction (locks, damaged casing or well box, etc) <br /> Problems Encountered During Purging and Sampling <br /> Comments <br /> I <br />