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' ETIC ENGINEERING <br /> GROUNDWATER PURGE AND SAMPLE FORM <br />' ProlectName. C Xxdf/ Well No. P1,1 iV 0,ate <br /> Pro <br /> lectNv '�� , / Personnel- <br /> I <br /> GAUGING DATA �^ <br />' Water Level Measuring Method. Measuring Point De=ptton:, <br /> Casing Total Req'd <br /> WELL Total Depth Depth to Water Water Column Mulbpherfor V purge Volume <br />' VOLUME (feet) (feet) (feet) X Casing Diameter (gal) (94 <br /> CALCULATION I 1 r` ✓ 0 2 4 6 /1_1Z7 <br /> U r� J• 0 16 064 1 , 7 1 <br />' PURGING DATA k 5 <br /> Purge Method Purge Depth Purge Rate" ` rn' <br /> Time <br /> Volume Purges(gal) <br /> - Temperature((,C) <br /> Specific Conductivity(umhos) <br /> Turbidity lColor V R <br />' Odor <br /> Casing Volumes <br /> 1� <br /> Dewatered'? <br /> Comments/Observations <br /> SAMPLING DATA Time Sampled [J Approx.Depth to Water During Sampling <br /> Comments <br /> I volume shipped Under Chain <br /> Sample Number 01 Container Filled r `""• of Custody at OC -Analysis <br /> Number Containers Type Preservative mL of L Turbidity ' Color c ,Method Comments <br /> Total Purge Volume Disposal/Containment Method _ J ¢ N <br /> I Weather Conditions <br /> Condition of Well Box and Casing affirfieofSampling <br /> Well Head Conditions Requiring Correction(loots,damaged casing or well box.etc) a <br /> Problems Encountered During Purging and Sampling <br /> Comments <br />