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GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name Well No Date <br />' Project No 5 15 C4 Lt 2. 13 U D Personnel <br />' GAUGING DATA <br /> Water Level Measuring Method =rrhzl xc¢ f rc-�Q Measuring Point Description -M C <br />' Casing T <br /> otal <br /> WELL Total Depth Depth to Water Water Column Multiplierfor Volume VOLUME (feet) (feet) (feet) X Casing Diameter (gal)CALCULATION 2 4 6 <br /> 3g Rd z G Z 1 lq [r 3 0 16 0 64 44 3 <br /> PURGING DATA <br /> Purge Method VaCUurrt 1rUCk Purge DepthC Purge Rate 3 t 9�r <br /> OG Oct t 4 ()q ! I 0G 1 Z <br /> volume Purges(gal) 3 Q S <br /> -Temperature(°C)' l 5 S <br /> -, t 4 0 ISO <br /> PH Y c <br /> 8 2Z G o -I itZ -IS 3 <br /> Specific Conductivity(umllos)� ; q� � 19 .� ZU �I <br /> " y <br /> Turbidity/Color-,; t- _ i_ <br /> Odom" <br /> Casing Volumes Removed_R r:.— <br /> Comments/Observations —Comments/Observations <br /> SAMPLING DATA Time Sampled Oq_ ! �J <br /> p Approx Depth to Water During Sampling 2.2. <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 Method Comments <br /> -43 ��r <br /> 3 3 Y "iv SOC M�3 <br /> r Total Purge Volume Q S D isposal/Con tai nme nt M ethod Lac,Ka,– jcv,K <br /> Weather Condrtions <br /> Condition of Well Boxand Casing at Tim of Sampling <br /> Well Head Conditions Requiring Correction(locks,damaged casing or well box etc ) N <br /> Problems Encountered During Purging and Sampling <br /> Comments <br /> PNS PR W TsM,P FORMS PURL=_10% <br />