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a' grim EM, I _ <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont.) o C�p , <br /> PROJECT NAME: Gk6a-S IC�I� _ WELL NUMBER: � T <br /> PROJECT NUMBER:— [v Z szu• �,LI PERSONNEL:_ _ Q7. <br /> SAMPLE DATA: �TIME Sr�MPLED: <br /> DEPTH SAMPLED(ll): r y <br /> SAMPLING EQUIPMENT:_� ' �k,_x <br /> COMMENTS: <br /> j <br /> Y(T�VYc SHIPPED UNDER -'ANALYSIS <br /> -5A41Pt,E 110.OF CONTAINER - r: riELR ... '. - <br /> j - - PRESERVATIVE nu;E " TTIA amy Colon c"u of CUSTODY If "C01t1+ENT5- <br /> F -rip. COHTAl ms TYPE - _ MTRATIOH - <br /> 1' AT�ti[YlNI " yMETHODt <br /> 1 <br /> i <br /> PURGE WATER.DISPOSAL-NOTES_ L! <br /> TOTAL DISCHARGE(gal): i <br /> :. <br /> ` .. r DISPOSAL METHOQ: . <br /> { DRUM DESIGNATION(S)LVOL!JME: <br /> I. COMM^8N S <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--if NO,add rAmmenis) <br /> ' WELL SECURI3Y.DEVICES OK(BOLLARDS.CHRISTY LID.CAS NG LID AND LOCK)?: . .l NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY? O� �. <br /> VtiELL CASTING OK?.` NO <br /> 1. COMMENTS: <br /> 71, <br /> GENERAL <br /> - ` <br /> i- <br /> WrATHER CONDITIONS: V ,r -- - - <br /> URE(spell CrF) <br /> 1 � TEMPERAT y° <br /> E <br /> a PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? �u v� <br /> - COMMENTS: <br /> r <br /> ' C.C. Project:Managei:. <br /> Job file: w <br /> Qther: -' <br /> r <br />