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' TIC ENGINEERING GYNEERING <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Project Name. C XXaAI Well No //IWIate EJ' <br /> Project NoPersonnel:'�� / <br />' — __ <br /> GAUGING DATA �^ <br />' Water Level Measuring Method. Measuring Point Description._ <br /> Casing Tata!Req'd <br /> WELL Total Depth Depth to Water Water Column MuItlpGerfor Vohlrrle Purge Volume <br />' VOLUME (feet) (feet) (feet) X Casing Diameter (gal) (gam <br /> CALCULATION <br />' 19 <br /> 0 1 S 064 1 a4 <br /> PURGING DATA <br />' Purge Method !! Yl ��f( Purge Depth Purge Rate <br /> Tme <br />' Volume Purges(gal) `% T 3 2(� 3 <br />' . <br /> Temperature(IC),., go <br /> pH --7 5`4 / <br /> Specific Conductivity(umhos) <br /> Turbidity/Color t IJV i!/ <br />' Odor <br /> .^Casing Volumes 01 ,v (p <br /> ; - <br /> ~` <br /> Dewatered'? <br /> 1` <br /> Comments/Observations <br /> SAMPLING DATA Time Sampled fI/ Approx Depth to Water During Sampling <br /> Comments <br /> volume r Shipped Under Cham <br /> Sample Number of Container Filled , s""ti of Custody at 40C Analysis <br /> Number Containers Type Preservative int_ar L Turbidity Color .,Method Comments <br /> h'1w 10 t4d rnL <br /> • - LYi�rf <br /> Total Purge Volume DlsposaVContainmentMethod <br /> Weather Cond,Uons UhV� <br /> Condition of Well Box and Casing at Time Sampling <br /> Well Head Conditions Requiring Correction(locks,damaged Casing or well box,etc) <br /> Problems Encountered During Purging and Sampling - Jd 12 <br /> IComments <br />