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GROUNDWATER PURGE AND SAMPLE FORM <br /> Protect Name _ C��C?/\/ 5N_lf No /'nL,✓ <br /> Date <br />' Protect No �'%5 �� �� / �Ca�� Personnel <br /> GAUGING DATA <br /> Water Level Measuring Method iVT IS Ar,6E U S ~ Measuring Point Description —0r-' <br /> WELL Total Depth � Depth to Water � Water Column � Multioiier{or Casing Total Req'd <br /> (feet) (feet) (feet) Casing Diameter I Volume PurgeVolume <br /> VOLUME _ _ X (gal) (cal) <br /> CALCULATION <br /> ► 7 0 16 1 Q 64 11 44 1 <br /> PURGING DATA <br /> Purge Method V4Cc-C .�„k2ni�Qc <��` Purge Deoth sC Purge Rate t <br /> Volume Purges(gal) <br /> Temperature(° <br /> PH - _ .� r 3 I <br /> 16('3 I I I I <br /> _Specific Conductivity(umhos)-`,. <br /> -'TLirbtddy/Color <br /> =s Casing Volumes <br />' Dewatered� �s <br /> -- <br />' Comments/Observations <br />' SAMPLING DATA Time Sampled P —lZ�H r Aoprox Depth to Water During Sampling <br /> Comments <br />' <br /> Sample Number of ontainer FoVolume Shipped under Cham <br /> Ciled of Cis ody al a°C Analysis <br /> Number Containers Type Preservauve (mL or L} Turbidity Color rY1v) Met')od I Comments <br /> ,t� I IVDA hCL. 1-(.)mL 11� I C'v��.r II V <br /> .w� � 11r�1 � I`1 C L- I`t�vh L- � ��f t/ ('C.�:-•� i � �r��,,ra�n <br /> I i I I I I I <br /> I i I I I I I I I I <br /> otal Purge Volume RpAI L EP 7-70 (y [C� <br /> rpleatherCorditions <br /> Condition of Well Box and Casing a Time of Sampling C� _ <br /> Well Head Conditions Requiring Correction(locks damaged casing orwell box etc ) <br /> Problems Encountered Dunng Purging and Sampling <br /> Comments - <br /> PNS PRCu7EMP F0RM5 PUR;ct096 <br />