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GROUNDWATER PURGE AND SAMPLE FORM <br /> Protect Name C�KbN Well No 'alt/r <br /> Dcie <br />' Pro}ectNo 5/5 ?q G2 13UO Personnel C /plJ CNS ; v' <br /> GAUGING DATA <br />' Water Level Measuring Method PEO , E Measuring Pomt Desc-iption -7'C� <br /> Casing Total Req d <br /> WELL TotaiDepth Depth io Water I Water Column Multiplier Volume I Purge Volume <br /> VOLUME (feet) (feet) (feet) Casing D+ameter <br /> CALCULATION - , I f I 6 (gal) _ (gal) <br /> Ll `% lZ 016064 I1 44 <br /> PURGING DATA <br /> Purge Method . VAC.uUtM Purge Depth SC/ZCeN Purge Rate `moi <br /> Time _ - 1 ! tu� <br />' Volume Purges(gal)~ <br /> _ <br /> 'Tempera#ure <br /> __Specrriie Conductivity(umhos) <br /> u'rb,drty/Color-.- y-' = <br /> ate' �ta�`� <br /> odor->; <br /> ==Casing Volumes Removed <br /> Comments/Obs ervatrons <br /> SAMPLING DATA Time Sampled l y Approx Depth to Water During Sampling (`_ <br /> Comments <br />' Sample Number of Container Volume Shipped Under Chain <br /> Filled of Custody at 40C Analysis <br /> Number Contam rs Type Preservauve rnL or U Turbidity color I (YIVI Method � Commen,s <br /> �I1VDA I hCG 140M I C Z-tu I y rte E� <br /> I ven I r)c L- L- (vt.J <br /> I I I I I <br /> I I I I I I i <br /> Total Purge Volume Dtsposal/Contasnment Method _77?-A+Le(` -r-O P,_Ufey-c c1 <br /> eatherConditions CL�y-(fin <br /> Condition of Well Box and Casing at Vme of Sampling V— <br /> Well Head Conditions Requiring Correction(locks damaged casing orwell box,etc <br /> Problems Encountered During Purging and5ampling A� <br /> Comments <br /> PMS PRoJ TEMP FoRMs PURGE 10% <br />