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GROUNDWATER PURGE AND SAMPLE FORM <br /> ProjectName . Ex�r- _ Well No _��_ Date 9'1 <br /> ProjectNo 5 l 5 Lt 2. 13 U U Personnel <br /> GAUGING DATA <br /> Water Level Measuring Method -_"-ri-tzr�ca Probc Measuring Point Description TG C <br />' Casrng Total Req'd <br /> WELL Total Depth Depth to Water Water Column Multiplierfor Volume Purge Volume <br /> VOLUME <br /> (feet) _ (feet} (feet) X Casing Diameter (gal} (gal) <br /> CALCULATION — <br /> 2 4 6 <br />' 2q 05 I q &3 W `!Z 0 16 0 s4 144 <br /> 2 s 3 4 tiq <br /> PURGING DATA <br /> Purge Method VaCUur+rt 1ryC1C Purge Depth !2Cnzg_/-2 Purge Rate AIM <br /> Time" 1 Z v U I Z o f 12 OZ I Z 03 <br /> Volume Purges(gal) ;�'r '�� <br /> s, �.� b 3 <br /> -Temperature(o C) �`�+_: ,,rr w, <br /> �� f� `i ! $ U IQ0 1q Z. <br /> pH <br /> Specrftc Conductivity(umbos)-�- .� 10 Z Z 10 5Co [ 05% 10S 55 <br /> Turbidity/Color- - - '' : __ }" h '9 9 <br />' Odor, rlj <br /> N <br /> r r P�- <br /> 1 �.. n ,•r <br /> Casrng Volumes Removed--; 6 <br /> Uewatered? ^hf w f y J <br /> - � _- - ry <br />' Comments/Observations <br />' SAMPLING DATA Time Sampled 12 OD Approx Depth to Water During Sampling z O <br />' Comments <br /> Volume Shipped Under Chain <br /> sample Number of Container Filled of Custody at 40C Analysis <br /> Number Containers Type Preservative mL or L Turbidity Color /N Method Comments <br />' w 3 V +-f0 �. 5,-Own r ra-9 <br /> 9Tar write <br /> Total Purge Volume t Disposal/ContainmentMethod QG jg,,K <br /> WeatherCondlttons c 10 U64 <br /> Conditton of Well Box and Casing at Tim of Sampling O <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwell box,etc) <br /> Problems Encountered During Purging and Sampling <br /> Comments <br /> PMS?RAJ TEMP FORMS PURG=-SQ% <br />