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Date <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name �X�r 7-39y.Z Well Number. <br /> Project Number 3� �Z ��� _ Personnel <br />' GAUGING DATA <br /> Water Level Measuring Method Ccz--&L Measuring Point Description <br /> Casing Total Req d <br />' To4Depthpth To Water Water Column MV46 <br /> Volume Purge Volume <br /> VO LL (feet) {feet) Cas (gal) {gaE} <br /> CALCULATION � 2 v _ 0 t6 ° l�s <br /> PURGING DATA <br />' Purge Method Purge Depths~ Purge Rate -� <br /> Yrrime`Pit} <br /> iti�G,�e•G11 C!`Tw.� L/����A}l L.�4}oij�{},;. <br /> �.Sj�cific:Cortdr�ctivit� <br /> ,r`T1ii fJ`✓�},,fi upps�+v,'}ice x{,,,,ca"-}.o�:+Fw'�6m>i`}x .�Aw}�`'.: <br /> •�Yvi{ti+�a+�0r'`Fii�Y'}�}rJ�,kS.k..{�,4��t;�ii'-}Ni`, r'Srw} <br /> nk]G'r145�j�iy ��'�" NYFrilk''ar!'r��}N{Y}Iyr�.'�`.+-'��r{ <br /> 11 <br /> "v acn v3v,on{F„rsa' +,.iacN,p rr s}`2'}'�`9� •''G <br /> �.+ S4Y`jjH�]y+�'$A+vi�afKt�l+�i.�ir �l4 <br /> .Ys^f^ Yf4"�-CF„maa"$Y]y }"'. c tO' { <br /> r.Cc,},u: <br /> Y'bYEF�„ vziwa�`ti^' ¢ao <br /> , B.=sa} huw„ Q['� <br /> Commerds/Observations l �e G 7&QZ <br /> SAMPLING DATA Time Sampled Approx Depth to Water During Sampling <br /> Comments <br /> ra„fi5'2�'i4`Y�Y" ,3sn,i;f'f}4f5yka af`,?+}%ate"�§i'� yis }r',.{4i` dv ',`^Rai✓Ta;f` .� rvl �w},c n}an.}';,of n-r.,.. S£.r nko-gnrAr <br /> v} Sit{}jr'�L x las SW^i.'S.n FSF aCAo W.v` �Syy �}t, ifn r 3^x,c[} ( �y..� c as; a -4 <br /> v � $ vµf� } ^' .i�y�*rP 3}mfiYaSr rh,of Cor w,ry-.�^•o}}la r o,.c„Y4'Y'£w;gwi <br /> u� =--- <br /> Total <br /> �[�AI{'.',..,§ ry�a�, .k��$3Y@ � 'a'� <br /> we rMr Jac Y- sax <br /> 44 `s s n <br /> w`�` c `."}.t�SBBClY�tiyi'CtiFrw �3��arst}�ti3iJE�7d:!TFjy-'p'9c^CAIo }V��r�nE��4f.�t•^'�`��.++.�`�� v hsv '"�`° <br /> Y I <br /> Total Purge Volume C7Disposal/Containment Method .:63 f rte,..S 36 <br /> Weather Conditions <br /> onddion of Well Box and Casing at Time of Sampling G <br /> I Well Head Conditions Requiring Correction (locks,dariaged casi Orwell box,etc) <br /> Problems Encountered During Purging and Sampling <br /> Comments <br />� l <br />