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GROUNDWATER PURGE AND SAMPLE FORM Date- <br /> Project NameWell Number r <br /> Protect Number E'IT 3I"'�r,2 Personnel ieZ _ <br /> GAUGING DATA <br /> Water Level Measuring Methodercr_ 1r. lac Measuring Point Description <br />' Total Depth Depth To Water Water Column Multiplier For Casing Tota! Req d <br /> WELL (feat) (feet) feet Volume Purge Vatirme <br /> ( ) Casing Diameter (gal) (gal) <br /> VOLUME .w \i _ <br /> CALCULATION X <br /> S�• "7�3 �l Z - sS7 2 1 s — j c. <br /> 016 0 i44 / - � �` <br /> PURGING DATA <br />' Purge Method ! Purge Depth ��i/7lHi Purge Rate <br /> Time <br />' 'V e Purg l n <br /> ohm �`(9a�, <br /> Tereiam rt4C ` A S <br /> lF4 n <br />' -Specify�ndt�cirtftt��}.tsn%j ,� � �� <br /> Tu t- J Cofor <br /> h x <br /> �asa�ig�o���es Ruvsd � <br /> N <br /> DewatereO y <br /> Comments/Observations <br /> SAMPLING DATA Time Sampled Approx Depth to Water DuringSampling <br /> p g <br /> Comments <br /> s�,pie ;�fum3s�r or" }(xraraFner = h � Free .` �R�urrcer Criair�of - , • - <br /> Nixzt�cs tr+ers `!' P:esewa�va :rti �'� Nr Cusiadg Az:atys�s r , <br /> Yip # t} t�sdFFy F.oE�r, gLd�C�Y1tV} Meit�at SEs, <br /> f <br /> G ti <br /> I f <br /> I <br /> Total Purge Volume Disposal/Containment Method �iT <br /> Pather Conditions 4 <br /> dition of Well Box and Casing at Time of Sampling _�'� _ <br /> Weil Head Conditions Requiring Correction (locks,damaged casing or well box, etc ) v1-e lv <br /> Problems Encounter d During Purging and Sampling <br /> Comments , <br />