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Am <br /> GROUNDWATER PURGE AND SAMPLE FORM Date <br /> Project Name 7 -3,Fv Well Number- tjdI3 <br /> 6 <br /> Protect Number Oze'3 Personnel <br /> GAUGING DATA <br /> Water Level Measuring Method r- Pry Measuring Point Description 7-oc <br /> Total Depth Depth To Water Water Column Multiplier PgCasing Total Req'd <br /> WELL (feet) (feet Volume Purge Volume <br /> (feet) Casing Diam (gal) (gal) <br /> VOLUME �,,, y <br /> CALCULATION y X 2�� r �� y 6Z 01s 064 � Z 5 <br /> PURGING DATA <br /> Purge Method w a r— Erb r,�r Purge Depth _.(%JAAGMol Purge Rate <br /> Time 4f0/o <br />' Volume Purged(gad} x7' � <br /> Teinpe tur-e{` <br /> PH > <br /> Spea fa comducii dy�!_mho). <br /> Turb)(4,1 Cobb= ; <br /> Ods <br /> Casing W uses.Removed <br /> tDewatered?, tiE <br /> Comments/Observationsh r ' v✓f cL CL <br /> J <br /> f <br /> SAMPLING DATA Time Sampled / 2 2 <br /> p Approx Depth to Water During Sampling <br /> Comments. <br />' sra f raa�n flr <br /> Satnp(e �iurxiber tTi Container,` V101ft�e Fgied Custody Analysis <br /> i icurri�er raers Type Preservabve {ml or E} Tud»dctY Cabe at d' 1N}- nnetr ivorrxrfergs <br /> VJ <br /> Total Purge Volume Sc ctb 01-y Disposal/Containment Method <br /> Weather Conditions <br /> ndition of Well Box and Casing at Time of Sampling it el <br /> C <br /> ll Head Conditions Requiring Correction (locks, damaged casing or well box,etc) <br /> Problems Encountered During Purging and Sampling <br /> Comments <<o L< <br /> r <br />