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' ETIC ENGINEERING <br /> GROUNDWATER PURGE AND SAMPLE FORM <br />' ProjectName. ! XXDA/ Well No _ KL&Oate 5 <br /> Project No -1- � , / Personnel: �� <br />' GAUGING DATA <br />' Water Level Measuring Method- (11'�CY'Fi9� OU Z _ Measuring Point©escnptlon: <br /> Casing Total Req`d <br /> WELL Total D"DepthtoWater Column Multiphertor Volume purgeVolume <br /> VOLUME {fee (feet) X Casing Diameter {gal) {ga!) <br /> CALCULATION 6j <br /> p �r <br />' Q 16 064 144 <br /> PURGING DATA�( , ',V <br /> Purge Method V � �UC� Purge Depth <::ZCfPJ2ik Purge Rate APM <br /> Time C9O i <br /> Volume Purges(gal) <br /> r Temperature(°C) -F <br /> pH <br />' Specific Conductivity(umhos) <br /> Turbidity/Color <br /> Odor _ <br /> D i <br /> .=.Casing Volumes Removed <br /> Dewatered'? <br /> 7-y <br /> Comments/Observations <br /> SAMPLING DATA Time Sam led tDID Approx Depth to Water During Sampling <br /> Comments <br /> Volume '�{ .+ Shipped Under Oiatn <br /> mFilled , <br /> - , <br /> Sample Nuber of Container Filled , rL of Custody at 4°C "�lysts <br /> Number Containers Type Preservative mL or L ` '"Turbidity Color c . 61hod � comments <br /> w.3 �7 Yr G� qorrtL ,ec,e rpiar r-i <br /> Srf- <br /> . Total Purge Volume Disposal/ContainmentMethod <br /> Weather Conditions C SLA <br /> Condition of Well Box and Casing at Time of Sampling <br /> Well Head Conditions Requiring Correction(locks,damaged casing orwell box,etc) t" <br /> Problems Encountered During Purging and Sampling <br /> Comments <br />