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GROUNDWATER PURGE AND SAMPLE FORM Date 5'c-lo 23 'ct3 <br /> Protect Name. EXzan eS 7-�94Z— Well Number: <br /> Protect Number- S373a•`k2 0263 Personnel* �D <br /> GAUGING DATA <br /> Water Level Measuring Method MAAC, PrD f- Measuring Point Description To G <br />' Tota! Depth Depth To Water Water Column Multiplier For Casing Total Req'd <br /> Volume Purge Volume <br /> WELL (feet) (feet) (feet) Casing Diameter (gal} (gal} <br /> VOLUME � x <br /> CALCULATION 4 g , ` �� 6 ., 2 4 0 j ~� <br /> (J "` 0 1& 064 144 f - <br /> PURGING DATA <br /> Purge Method Vacilum Tf'yck- Purge Depth I—S&// e2 0,27 h Purge Rate <br /> 134 5' <br /> M r4S v t� <br /> \S4~ <br /> l lig LiEI G Lst1WALM O��:` ✓ <br /> r a. <br /> ~VL�.fF rr}rH ~-ry�ti 4 YrY}••~J Y] +{~~~ <br /> IC <br /> �5i Emoar } Q .f' <br /> Comments/Observations fit►-�1a e�� f O1 WG► EAS12 -3 <br /> SAMPLING DATA 3� <br /> Time Sampled. �„ Approx Depth to Water During Sampling <br />' Comments <br /> siamplo, l=bwvf c4mo3dna yairs*tat"Elied ` lip teb[Irsdec Ciaiaiit of <br /> t+t=bw cmtmiws Tyw (Mt Atlg Tuitdi4g- 6d r: <br /> 04~��Y1t� 1s�emaG yrs <br /> 3 V OA r 46 A-L <br /> TWW - <br /> I <br /> tal Purge Volume Disposal/Containment Method <br /> either Conditions �s� �� <br /> Condition of Well. Box and Casing at Time of Sampling <br /> Well Head Conditions Requiring Correction (locks, damaged casing or well box, etc) /y n4 � <br /> Problems Encountered During Purging and Sampling. aa _ E'�c}' -LGG�Ae Cj 01(-- <br /> Comments <br />