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I <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name C��bN Well No n <br /> .gate <br /> Project No SSS �� �2 1 �C�C� Personnel C �l� �F(�' <br />' GAUGING DATA <br /> Water Level Meas iring Method �/7' RFgrc 210,062E Measuring c)oint Descnotion i—C�— <br /> WELL T otai Depth Depth to Water I I Water Column Muftiehe"for Casing i Dial Req C <br /> Volume I Purge Volume <br /> VOLUME (feet) (feet) (feet) Casing Diameter (.al) qal <br /> _ x _ (gal) <br /> CALCULATION 2 I � <br /> 0161064134" II <br />' PURGING DATA <br /> Purge Method VAC�V)-) i x-) cr C Purge Depth sC7ZsQ��V Purge Rate <br /> Time =- µ !�� q -3 <br /> Volume Purges(gal) <br /> =Temperature{°C)w (� <br /> PH <br /> -edit Canducttvity(tmhos) <br /> 1 <br /> .Odor_ _ AOI t�i'v ��� I /i✓� <br /> =r <br /> .CasingVolumesRemoved^ <br /> -_ -- „" - <br /> Comments/Observations <br />' SAMPLING DATA Time Sampled _ ��v Jr Approx Depth to Water During Sampling <br /> Comments <br /> volume <br /> Sample [N�umber.of <br /> Container Sh,ppeo Under Chain <br /> Number Type Preservative <br /> Filled Turbrdrt Color of Custody at caC �ralysrs <br /> ( ) y f"/V1 Method I Comments <br /> IVOA 1 HC-c- IqornL I 7 > c -v�'i `J r+g rrnR::l <br /> otalPurgeVolume Disposal/ContainmentMethod _7P-AiLgP 7-D Ron&tL <br /> eatherconditions <br /> ondition of Well Sox and Casing atTlm of Sampling � <br /> Well Head Conditions Requiring Correction(locks damaged casing orwell box etc ) l� <br /> Probiems Encountered During Purging and Sampling <br />' Comments <br /> Pv5 PROD YLUP�ORF/5 PUa;E1C4 <br />