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GROUNDWATER PURGE AND SAMPLE FORM <br />' Protect Name Cxx Well No Mw Date 11.1'.4 qlg_ <br /> Protect No 5153Q4 Personnel 0 <br />' GAUGING DATA <br /> Water Level Measuring Method =n�c��cg P--o 5e _ Measuring Point Description <br />' Casing Total Req'd <br /> WELL Total Depth Depth to Water Water Column Multipherfor Volume Purge Volume <br /> (feet) (feet) (feet) X Casing Diameter <br /> CO CULATION � — {gal) _ (gal) <br />' 2q 90 22Yso ^ � ICo z s � 5B l3 � <br /> o 1 s a 64 44 5 <br />' PURGING DATA <br /> Purge Method VACUVrn _7"yCK Purge Depth 5creon Purge Rate 3 y S-N <br /> Time.` <br /> It . I 31 1132 It 33 <br /> Volume Purges(gal) �� x f rjCk 13 . 5 <br /> ��- <br /> Tete etature °C I y , b19 •y O O 2 0. 2 <br /> p ( ) w ; <br /> , <br /> Spectftc Conductivity(umhos) g rJ g <br /> Val <br />' iTurt�iclity/COlor' - <br /> Odor r _ <br /> f-k C <br />' "Casing Volumes Removed Z 3 <br /> Dewaterev <br />' Comments/Observations <br /> SAMPLING DATA <br /> Time Sampled _ l E 3 C� _ _ Approx Depth to Water During Sampling Z Sl <br />' Comments <br /> Sample Number of Container Volume Shipped Under Cham <br /> FillAnalysis <br /> m � M m <br /> Number Containers Type Preservative ed Turbidity Color of Custody at 4 C Method Comments <br /> _ <br /> L or L <br /> Total Purge Volume t`'t Disposal/Containment Method ±C0. r^i <br /> Weather Conditions C o V <br /> Condition of Well Box and Casing at Time of tampling <br /> Well Head Conditions Requiring Correction(locks,damaged casing grwell box,etc ) <br />' Problems Encountered During Purging and Sampling N <br /> Comments <br /> OVI;PRaj T=Mp Pon%c aURC�+'1a'i <br />