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GROUNDWATER PURGE AND SAMPLE FORM <br />' Project Name Cb Well No V Date <br /> ProlectNo s/J �� / �U�� Personnel CH/q,!5 <br /> 1 GAUGING DATA <br />' Water Level Measuring Method Measuring Point Description <br /> Cas:ng Total Req d <br /> WELL Total Depth Depth to Water Water Column Multipiierfcr Volume Purge Volume <br /> VOLUME (feet) (feet) (feet) X Casing Diameter al <br />' CALCULAT€ON I 4 6 (g ) _ (gal) <br /> Z2 .b2 1 �, 1% 0 16 1 0 64 � 1 410 <br /> 2 .77 31 <br /> PURGING DATA <br /> Purge Method ACS /t c cr' Purge Depth SCIQE5E/V Purge Rate 3 � <br /> t Time <br /> 042- <br /> Volu <br /> ( t43 <br />' ;me Purges(gal) ;= a <br /> Temperature <br /> pH <br /> h <br /> Specrfic Conductivity(umho§)-' (p <br /> F@ <br /> x TurblaylColor t'_w may- w: � � LUL <br /> r t rZ f tsu�� G r r <br /> -Odom'^}� i ;ter;=v"Ts= �/O <br /> .,s ., r <br />' --Caslsig Volumes Removed y= <br /> Dewatered� <br />' Comments/Observations <br /> SAMPLING DATA Time Sampled f t Sy Approx Depth to Water During Sampling �' r <br />' Comments <br /> Volume Shipped Under Cham <br /> Sample Number of Container Felted of Custody at a°C Analysis = <br /> Number Containers Type Preservative (mL or h) Turbidity Color fYRll Method Comments <br /> IVDA I HCL �OML l I +✓ des tT t9 <br /> i I I I <br /> I I I I I <br /> Total Purge Volume DlsposaVContainmentMethod T 'LE -r-O PQ64LC— <br /> Weather Conditions <br /> Condition of Well Box and Casing at Time of Sampling <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwellbox etc )!V —1 <br /> I Problems Encountered During Purging and Sampling <br /> Comments <br /> PMS PRO-1 TEMP PCRM$PURGc1 C96 <br />