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GROUNDWATER PURGE AND SAMPLE FORM (cont.) aat�:" C) c' <br /> l c�St t ' . <br /> PROJECT NAME: �� �- WELL r:IMBER:__ /�+�f.� <br /> PROJECT NUMBER:--_ I O. PERSONNEL: <br /> SAMPLE DATA: <br /> TIME SAMPLED: - <br /> DEPTH SAMPLED(II): 60 — <br /> SAMPLING EQUIPMENT: - <br /> COMMENTS: <br /> . - SAMPLE ND.OF .;:. CONTAINER P 'rIkLD' ..;SFpppEDyNWER `ANALYS, > .. <br /> VOLV E - - _ <br /> . -1+0. = CONTAINERS RESERVAYIVE - :FILLED TURD,DITY COLOR CHAIHOFCUSTOOT ;.,c01A1,1EM <br /> •TYPE --. RLTRATION: .. - FIEO'IESi x <br /> y T41C(Y." -.(ix <br /> AETH081 : ' <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal): 3 ` <br /> DISPOSAL METHOD: SJ` .. 1QciE <br /> DRUM DES]GNATION(S)/VOLUME: <br /> COMMENTS.` <br /> J <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO -it NO,add comments) <br /> . <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID CAS NG LID AND LOCK)?: CES' NO <br /> INSIDE OF WELL HEAD AND OUTERCASING DRY?: NO <br /> ". <br /> WELL CASING OK?: YI= NO . <br /> COMMENTS <br /> F. <br /> ` 1 GENERAL <br /> WEATHER CONDITIONS: <br /> _T . cify_°C°Fl:TEMPERATURE(spe <br /> - - - - - <br /> 3 j PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? N -- <br /> COMMENT'S:�GInJG- <br /> C.C. Project Manager, <br /> :Imn Fire. <br /> r ; <br /> 3 <br />