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' TIC ENGINEERING E 1N ING <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> Pro}ectName C /-XQAl Welt No � ate._ <br /> ProectNo d12,i`­,(' <br /> ! / Personnel: <br />' GAUGING DATA <br />' Water Level Measuring Method. Measunng PointDescnpuon• <br /> Casing TotalRe <br /> WELL Total Depth Depth to Water Water ColqDumn Multiplierfor Vokrme Purge Volume <br />' VOLUME (feet) ` (feet) (feet) X Casing Diameter (94 Z (g4 <br /> CALCULATION — <br />' 016 064 144 <br /> PURGING DATA� <br />' Purge Method V � lrl1 _ Purge Depth Purge Rate AVVY'Ll <br /> Time 21 `l d—J dl;?- <br /> Volume Purges(gal). <br /> a Temperature(°C) _ { '20 )'( 3 D. (V aQ- 5 <br /> _ Af +a SYa flcfif4,�_ <br /> pH <br /> ?. q2 .-? l '7 `3 x. 35 <br /> 0 Specdic Conductivity(umbil• O( 0 q (`"l <86 p <br /> Turbidity/Color ,,,,�1 � D a � <br /> ' lX � <br /> Odorrj <br /> ��Casing Volumes Removoci�., } O v] , v o� 3•U 3 <br /> <, <br /> Dewalil <br /> Y <br /> IComments/Observations <br /> ISAMPLINGDATA Time Sampled 1 1130 Approx Depth to Water During Sampling l <br /> Comments <br /> Volume Shipped Under Chain <br /> Sample Number of container Filled L s" � of Custody at 4°C Analysis <br /> Number Containers Type Preservative ml_or L Turbidity Color 4 .Method Comments <br /> Total Purge Volume G9 aQDisposal/Containment - NA-< <br /> I Weather Conditions <br /> Condition of Well Box and Casing at Tifne of Sampling <br /> Well Head Condltlons Requlnng Correction(locks,dam ed casing orwell box,etc) <br /> Probferns Encountered During Purging and Sampling <br /> Comments <br />