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GROUNDWATER PURGE AND SAMPLE FORM (cont.) Date: ZS a <br /> PROJECT NAME: X — ��5� <br /> WELLIVUMBER:�Z�.J <br /> PROJECT NUMBER:�O� 6. �� PERSONNEL: ----------------------- <br /> SAMPLE DATA: <br /> TIME SAMPLED: <br /> DEPTH SAMPLED(ft): S <br /> SAMPLING EQUIPMENT: e � <br /> COMMENTS: [ ` <br /> SAMPLE N0.OF COHikNER -. 3- - AELO VOLUME, ... '„ :: p' 'r-S♦9PPEOUNPEA -.ANALYSIS �C; s <br /> HO. CONTAI : :. PRESERVAT]YE FILTRATION < - CO <br /> HERS TYPE' riLLED` TURQIOiTY COLOq 'CNAINOCUSTODY <br /> CTHOOJ °s t <br /> ✓'. Lid•.:.:':.= <br /> 12 <br /> Tvtr <br /> Sts <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal): (.3 <br /> DISPOSAL METHOD _�`v <br /> DRUM DESIGNAT#;ION(S)NOLUME:�lq s` <br /> COMMENTS: N t . <br /> WELL_HEAD CONDITIONS CHECKLIST(Circle YES or NO--if NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID;CAS.NG LID AND LOC ?: <br /> -'1} - <br /> K) YES NO L- <br /> INSIDE OF WELL HEAD OUTER GASING DRY?: YES NO <br /> t WELL CASING OK?: ES O <br /> j. <br /> i COMMENTS I oa G GOl! �6 rN uy� 4 <br /> ` GENERAL: <br /> WEATHER CONDITIONS:' Q <br /> TEMPERATURE(specify'C/° <br /> ( P Y F)' <br /> SIE <br /> I'RO$LEMS.ENr UNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS: . <br /> cc: Project Manager. ... ....: <br /> f Jab File: <br /> Other: <br /> =r' <br /> FY <br /> � ti rs3� F <br /> gar���-t•;�Z " ? t ... <br />