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ETIC ENGINEERING <br />' GROUNDWATER PURGE AND SAMPLE FORM <br /> n / <br /> �' $0 <br /> C XXdV WeIlNo �-1 ate <br /> ProjectNo <br /> Personnel: t� <br /> GAUGING DATA <br /> Water Level Measuring Method Measuring Point Description. ::fj@�� <br /> Casing Total Req'd <br /> WELL TotalDepth Depthto Water Water Column Mulhplterfor Volume _Purge Volume <br /> VOLUME (feet) _ {feet) {feet} X CasingDlameter (g�} (g_ <br /> CALCULATION 2 vt� 4 p• .W 3� , 4 6 <br /> { fl 16 Q 64 144 �' � '�� <br /> PURGING DATA <br /> Purge Method Purge Depth Purge Rate AOrn' <br /> Time i = <br /> Volume Purges(gal) <br /> < Temperature(o C)'-1711 <br /> r ! U <br /> SpecdicConductivity(umhos)''v <br /> Turbidity/Color <br /> ' LO{..c.? r I✓_:J�' �to� y�,� <br /> Odor <br /> =Casing Volumes Rern veq44 Z� q <br /> !"#A. /�� IV <br /> Dewatered? R <br /> IComments/Observations <br /> ISAMPLING DATA Time Sampled f Approx Depth to Water During Sampling <br /> I Comments <br /> Volume s ra. Shipped lander Chain <br /> Sample Number of Container Filled ' of Custody at 4°C Analysis <br /> Number Containers Type Preservative mL or l Turbidity Color Method Comments <br /> �,rr3 Vim- HCA L D Tfi L. 1f>L'j cua r"'�q <br />' � I <br /> Total Purge Volume a Disposal/Contammenl Method <br /> WeatherCondltions () <br /> Condition of Well Sox and Casing atTl of Sampling <br /> Well Head Conditions Requiring Correction(locks,damaged casing Orwell box,etc) <br /> I Problems Encountered Ounng Purging and Sampling <br /> Comments <br />