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1 <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name CxxbN Well No ' pd- ;Da*a <br /> Project No S/J -�-:3,-? �2 /�U<� Personnel <br />' GAUGING DATA <br /> Water Leve! Measuring Method �/T-`fZ�.4�� U,, F Measuring Pont Descno�ion i C.G <br /> I P <br /> WELL TotalDepth Depth to Water I I Water Column N1ultlpliertor VolumCasing Total eq d <br /> e ��Purge Volume <br /> VOLUME (feet) (feet) (feet) Casing Diameter <br /> CALCULATION — X (cal) _ (gal) <br /> } �} 4 1 6 <br /> u' o161o64I144 I '4 <br />' PURGING DATA <br /> Purge Method Purge Depth sGIZ:;�5-e/y Purge Rate <br /> Time 1455 6 1,45? <br /> Volume Purges(gal) ,� '� - U 1q <br />' `Temperature <br /> NO <br /> Casltig Volumes Removed <br /> - -- - ed� vDewatre <br /> I I f <br />' Comments/Observations <br />' SAMPLING DATA <br /> Time Sampled p Approx Depth to Water During Sampling <br /> Comments <br />' Volume Shipped Under Chan <br /> Sample Number of contdrner relied of Custody at 4rC .nalysrs <br /> Number Containers Type PresenraVve {mt or L1 Turbidity Color I n,INy Method comments <br /> IVDA, Hct_ I4oML I ���..� 'wr�l v =C) IM, EI <br /> I <br /> I I I I I I I <br /> oral Purge Volume 6ALt-0 t,�4S DlsposaXontalnment Method SAI LE 7-0 4L C— <br /> eatherCondittons <br /> Condition of Well Box and Casing atTi e of S2mplrng <br /> Well Head Conditions Requiring Correction(locks damaged casing orwel]box etc) <br /> Problems Encountered During Purging and Sampling <br /> Comments <br /> PMS PAQJTEMP P0RM$PURuctp96 <br />