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GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name _ Well NoDate �a <br /> Project No s� �l- / /�U ^_ Personnel <br />' GAUGING DATA <br />' Water Level Measuring Method //?71e1-]R?Ce apj-e Measuring Pont Description G <br /> WELL Total Depth Depth to Water Water Column Casing Total Req'd <br /> Mu€tiplierfor Volume Purge Volume <br /> VOLUME (feet) _ (feet) (feet) x Casing Diameter (gal) — (gal) <br /> CALCULATION �O �� 2 6 i� �� — C 7 <br /> r, n <br /> ✓��" C7� � �" 0 16 06 144 <br /> PURGING DATA <br /> Purge Method y GV V f 1'(.Z Purge Depth Purge Rate h - <br /> . <br /> '.Time- <br /> Vo lume P. <br /> .TimeVolumePurges(gal) „ <br /> <Ferriperature(°C) `: � y ', L� , j ��j• �'} <br /> 54 <br /> ecrftc Conductmty(uFhas �� J' <br /> �Castng Vot"umesRernov <br /> Dewate�diµ a ND D <br /> Comments/Observations <br /> SAMPLING DATA Time b o Sampled p � Approx Depth to Water During Sampling 5J FT <br /> Comments <br /> I Volume w Shipped Under Cham - <br /> Sample- y Humber of ,Container, , <br /> Number Containers r Type ' ' f'reservative Filled , Turbldl �. of Custody at 4°C Analysis <br /> mL or L H Coior M Method -r Comments - <br /> Total Purge Volume Disposal/ContainmentMethod 72) <br /> WeatherCondrtions <br /> ondition of Well Box and Casing at Time of Sampling <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwell box,etc ) <br /> LLU— <br /> Problems E=ncountered During Purging and Sampling <br /> Comments <br /> IPNffiPRCU TEMP F0RMS-PURGE1o9e <br />