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F a. <br /> 6 <br /> Z. <br /> p <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont.) Data' <br /> PROJECT NAME: �CX(3�'1 —/���� WELL NUMBER: � <br /> PROJECTNUMBER:�C�Z��.r7 _ PERSONNEL: IT) laa <br /> SAMPLE DATA: <br /> TIME SAMPLED: ` <br /> DEPTI4 SAMPLED(ft): <br /> SAMPLING EQUIPMENT: <br /> COMMENTS: /t,0 �. <br /> Sd&WLE NO-OF CONTA114ER :: -- `rr VOLUMEllnilll.i�-'�1�1. r, 4.i' ;'SNIPPED UNOFR <br /> NO. COHTAIRFpS TypE PRESERVATIVE - flEID.;; RLLFDr TURD7DITT COI;OFr CIWNOFCUSTOOT <br /> _. ., flLTAATION . .;.,< _ }.rEt]UE51' C.os11.EHTS <br /> ;gS <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal):_ !j <br /> DISPOSAL METHOD: - <br /> DRUM DES IGNATION(S)NOLUME: <br /> COMMENTS: <br /> WELL HEAD.CONDITIONS CHECKLIST(Circle YES or N -if NO.add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRIFn*LI ASING LID AND LOCK)?: .YES NO <br /> INSIDE OF WELL HEAD OUTER CASING DRY?:{ YE NO <br /> WELL CASING OK?: YES NO <br /> COMMI=NTS: C/�? �[ -r` . <br /> - GENERAL - <br /> WEATHER CQNDITIONS: f <br /> :. TEMPERATURE(specify 00017)= rS <br /> PROBLEM F_NC UNTERED DURING PURGfNG OR SAMPLfNG? <br /> COMMENTS: <br /> C.C. Projmt Manager: <br /> 1 <br /> Job File: <br /> 1 Other: r <br /> r ' <br /> r <br />