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b <br /> gn <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont.) Date: n n <br /> PROJECT NAME:_ <br /> WELL NUMBER: W <br /> PROJECT NUMBER: L PERSONNEL: <br /> SAMPLE DATA.- <br /> TIME <br /> ATA:TIME SAMPLED: 1010 <br /> DEPTH SAMPLED(fl): Z <br /> SAMPLING EQUIPMENT: <br /> Ice- <br /> COMMENTS: <br /> SAuPLE -HQ OF A:.. COHTAINEH <br /> . COHrAIHEAS TYPE :' PAESSRYATIYELRELD RL:LFJR YtfA&DlSHIPPEDDNDER <br /> TRATIOH (m urq COLUft C"NofC6w y <br /> •;:'AT6'Cit4vj A-0 <br /> �Rq - CAi-0AiENTS _ <br /> e5 3 <br /> . PURGE WATER DISPOSAL NOTES: . <br /> TOTAL DISCHARGE(ga)): <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)/VOLUME: <br /> '•COMMENTS: ' <br /> .r <br /> s j <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--if NO,add comments) <br /> WELL'SECUAITY GEVICES.OK(BOLLARDS,CFIRISTY LID,CASiwr,LlD AND LOCK�;: E <br /> d . <br /> INSIDE OF WELL HEAD ) NO <br /> OUTER CASING DRY?: Np <br /> WELL CASING OK?: E NO <br /> - <br /> �w. <br /> COMMENTS: fu <br /> t' GENERAL <br /> WEATHER CONDITIONS: 4 <br /> x Uwa <br /> TEMPERATURE(specify°CrF): <br /> '_.. <br /> s17 <br /> PROBLEMS ENCOUNTERED DUPING PURGING OR SAMPLING? o <br /> � COMMENTS: M-C: N <br /> k- <br /> S <br /> C.C. Pro'a <br /> J Al " <br /> ` Job Fife: <br /> 5 '4 <br /> S <br /> �f � ' <br />