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ETIC ENGINEERING <br /> GROUNDWATER PURGE AND SAMPLE FORM <br /> ctNarne <br />' ProleE ,,YXo V Well No ate moi' <br /> Protect No �� , Personnel: <br />' <br /> GAUGING DATA <br />' Water Level Measuring Method. lwerenc2 Measuring Point Description <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 / "— <br />' <br /> 10161064 <br /> 144 <br /> PURGING DATA` [� <br /> Purge Method Y1 � y( Purge Depth Purge Rate <br /> Time <br /> Volume Purges(gal) <br /> Temperature( C) <br /> . <br /> pH <br /> Specific Conductivity(umhos) <br /> Turbidity/Color _ (U <br /> u <br /> I Odor <br /> =.Casing Volumes Rema%;ed", A <br /> EDewatered'? <br /> comments/Observations <br /> I SAMPLING DATA Time Sampled �� A p g Sampling 1 � _�r <br /> p pprox Depth to Water Durin Sam lin <br /> Comments <br /> Volume •, shipped Under Cham <br /> Sample Number of Container Filled ' x r of Custody at 4oC Analysis o <br /> Number Containers Type Preservative mt-or l Turbidity Color /N Method Comments <br /> V �2 Vim- G( gdmL t Com+ - {� e;,3 <br /> Total Purge Volume ��Z' ,�u l(hS DisposaVin <br /> ContamentMeihod <br /> WeatherConditlonS V'tl <br /> Condition of Well Box and Casing at Time of Sampling <br /> Well Head Conditions Requinng Correction(locks,damaged casing or well box,etc) <br /> Problems Encountered During Purging and Sampling Vt-S� <br /> IComments <br />