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1 <br /> z <br /> GROUNDWATER PURGE AND SAMPLE FORM Date' ` <br /> 1 Protect NameWell Number > <br /> Protect Number 837.3„ �� �d PersonnelL <br /> GAUGING DATA <br /> Water Level Measuring Methodz9ffM,' Measuring Point Description �� <br />' Casing Tota! Req d <br /> Total Depth Depth To Water Water Column Multiplier For Volume Purge Volume <br /> WELL (feet) (feet) (feet) Casing Diameter <br /> _ (Jai) (9a[) <br /> VOLUME it <br /> CALCULATION 2 6 �. <br /> c1� O �� o 16 16W 144 I f Z <br />' PURGING DATA <br /> Purge Method !rte Purge Depth Purge Rate �v <br /> Time ` <br /> Y- <br /> Volume Purged"(gaq , <br /> vTerratt�ne��j. A - S <br /> 04 <br /> n F v <br />' �6etiCF7CJ[ 4tfft]t 1 <br /> Tur�'tdrty}��oc <br />' casfnd Vtitpmei Removed <br /> Dewatered' v <br /> Comments/Observations <br /> SAMPLING DATA Time Sampled ff _ Approx Depth to Water During Sampling <br /> Comments n <br /> satri;)w - .,.. ,. � .. .. <br /> :�ppecf tJrsder�tiain or ' <br /> t�skxsber at 4:;0n nor u V` Ped_ > tadg Arrafy <br /> Ntmiber < i rfers Tym Preserya” #tial Et Turwdklyfdctr: g�4'[~��t(�} Meth o` ' Ca�KterEfs.` <br /> Ggffay <br /> Total Purge VolumeDisposal/Containment Method <br /> ather Conditions <br /> edition of Well Box and Casing at Time of Sampling G>C CG ra <br /> Well Head Conditions Reguinng Correction (locks damaged casing or well box, etc) <br /> Problems Encountered During Purging and Sampling k%--1 <br /> Comments �� _. <br />