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' ETIC ENGINEERING <br /> GROUNDWATER PURGE AND SAMPLE FORM <br />' ProjectName. C XX01/ Well No �- _ ate ' Ifi <br /> • Personnel:Pro ectNo '� / <br />' j <br /> GAUGING DATA <br />' Water Level Measuring Method. (WeY<-6tClL, Measuring PointDescnption,, <br /> Casing Total Req'd <br /> WELL Total Depth Depth to Water Water Column Multiplierfor Volume Purge Volume <br />' VOLUME (feet) (feet) (feet) X Casing Diameter (gal) (gal) <br /> CALCULATION 1� O ® 4 6 `O 1 j <br /> U I ti! 0 16 0 64 _44 D <br />' PURGING DATA <br /> Purge Method V �( ^_ Purge Depth Purge Rate WtTL, <br /> Time 1340 13` 1 1349- 13 Y3 <br /> Volume Purges(gal) <br /> Temperature(°C) } -�� -- �jj �� , �� 3 `)n <br /> pH / CFD -2, <br /> I . Specific Conductivity(umhos) 7 <br /> Turbidity/Color G if l�f <br /> Odor <br /> Casing Volumes'Remoried —, O i 1 <br /> Dewatered? <br /> CommentslObservations <br /> SAMPLING DATA Time Sampled Approx Depth to Water During Sampling <br /> Comments <br /> volume Shipped Under Chain <br /> Sample Number of Container Filled o� r,xrr of Custody at 4°C Analysis ' <br /> Number Containers Type preservatilveM <br /> ( L or L Turbidity Color , -Method d comments <br /> I <br /> - AnSrt< <br /> Total Purge Volume � �-- �(X,U({�il� DisposaVContainmeniMethod o IVPWeather Conditions <br /> Condition of Wel!Box and Casing at Tlme of Sampling <br /> Well Head Conditions Requiring Correction(locks,damaged casing or well box,etc) <br /> Problems Encountered During Purging and Sampling <br /> IComments <br />