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GROUNDWATER PURGE AND SAMPLE FORM Date. Fire-b 23 *q3 <br /> Protect Name-_&YO-A 2S *7-3 9,4 Z— Well Number- W <br /> Project Number -33-13q A2 oZ63 Personnel- <br />' GAUGING DATA <br /> Water Leel Measuring Method. 14A"-C- Pre he- _ Measuring Point Description —T—ac— <br />' Total&DepthDepth Water Water Column Multiplier For CasingTotaliegd <br /> WELL (fet) (feet) Casing Diameter VolumePurge Volume <br /> voLLIME � _ (gal) (gal) <br /> CALCULATION ?0 A3 2. 7 0 126 0 64 1 44 � ��s �' <br /> PURGING DATA <br /> Purg�eJ Method Vacuum TrvGV-- Purge Depth 411 C.(0`2 Purge Rate � ZA Apr" <br /> Z-3 <br /> y. `J.. {v�k t�yT• 141VJ�.t�vr h r <br /> •.Y ? t L4 <br /> 06watere <br /> T' <br /> Comments/Observattons 70 T e,41" yr -I <br /> SAMPLING DATA Time Sampled /73 Approx Depth to Water During Sampling _ <br /> Comments <br /> - , S'� vrroer rts�a ar- . - <br /> Sam* Nwrz?er,0" Cnnm rter Custaag Analysis <br /> £+ELurtDer ripr ria E eser anre (A*ri u rdttq r taE ata'C �i ,hfielrr its <br /> I114 IV Z� 3 v oA l+ct 46n•- �� /�,�... `/ iia Q X <br /> tal Purge Volumed _ Disposal/Containment Method <br /> ather Conditions W�rS <br /> Condition of Well Box and Casing at Time of Sampling —T U <br /> f <br /> Well Head Conditions Requiring Correction (locks, dama ed casing or well box, etc) <br /> Problems Encountered During Purging and Sampling _._ e-jC-rS <br /> Comments <br />