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Z &i <br /> E��H <br /> Date: c� <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont.) <br /> PROJECTNAME:_ 400. J--� �� WELL NUMBER: �'I ^� <br /> PROJECT NUMBER: •j PERSONNEL:,� . <br /> SAMPLE DATA: <br /> TIME SAMPLED, ��_ <br /> DEPTH SAMPLED(It): <br /> SAMPLING EQUIPMENT: C lc' <br /> COMMENTS: <br /> y' ....Y, VOLUME -F - -a'':• s:'SHIPPEDUNDEA ''ANALYSIS -k.4v. - <br /> S"a l£ NO DF.�:, CONTAINER PRESERVAnvc �E�' ; Fill'D TURBUXTY COLOR 0WHOFCUSTODY xHECUEST ! C094+AENTS - <br /> '-. N0. CONTAINERS TYPE- '.- .. fTLTAATION .,...�:. w -.. • c <br /> ::,:.y t�+�n.. ,'.... -.,. :j: . .Ai.�ci�'+rn :::�'r�+Er►tom .• .� <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal): ' <br /> DISPOSAL METHOD:. t u,N1 <br /> DRUM DESIGNATION(S)NOLUME: !2I Q- <br /> COMMENTS: <br /> WELL HEAL?CONDITIONS CHECKLIST{CircleYES or rd0—if NO,add comments} { <br /> WELL SECURITY DEVICES OK(BOLLARDS,CliRISTY LID AS'NG LID AND LOCK)?: O. =- <br /> INSIDE OF WELL HEAD A OUTER CASING DRY?:, ES O <br /> WELL.CASING OK?: YE NO <br /> COMMENTS: fl� Tom[ U/l Gres CS! <br /> :GENERAL-- - <br /> "R, ` <br /> WEATHER CONDITIONS: <br /> � <br /> TEMPERATURE R!=(specify�Cf�: '� <br /> z <br /> PROBLEMS ENCOUNTERS[]DURING PURGING OR SAhi?LING? V <br /> COMMENTS: <br /> C+.c.'Project Manager' <br /> Job Fete <br /> Other. <br /> i <br /> w <br /> r.�sr <br /> s,t <br />