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GROUNDWATER PURGE AND SAMPLE FORM (cont,) oats <br /> "-,exon -7�- 39 4 Z� <br /> PROJECT NAME � WELL NUMBER, V3 <br /> PROJECT NUMBER g�007^29" N68 PERSONNEL: _ _ XL 14114W <br /> SAMPLE DATA: <br /> TIME SAMPLED <br /> DEPTH SAMPLED (€t)_ <br /> SAMPLING EQUIPMENT so, te- <br /> COMMENTS- <br /> VOLUME S"MED UNDER ANALYSIS <br /> SAMPLE NO of CONTAINER PRESERVATIVE Fyrn FILLED TURBIDITY COLOa cMmoFcUsioDY REQUEST COtdN/E}175 <br /> NO. CONTAINERS TYPEC FILTRATION (mtw0 AT4-C(YAQ (MEnfoD) <br /> U< 3 V0 A �t /' eta=�� 1 �� yes TPW rte; <br /> 1 <br /> PURGE WATER DISPOSAL NOTES. <br /> TOTAL DISCHARGE (gal) <br /> DISPOSAL METHOD. <br /> DRUM DESIGNATION(S)IVOLUME EA La41:W-1 <br /> COMMENTS- <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO --if NO, add comments) <br /> WELL SECURITY DEVICES OK (BOLLARDS,CHRISTY LID,CASING LID AND LOCK)?. NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY? QM NO <br /> WELL CASING OK?. <!�n NO <br /> COMMENTS <br /> GENERAL <br /> WEATHER CONDITIONS <br /> TEMPERATURE(speedy DcrF) <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS- <br /> c.c Project Manager <br /> Joh File <br /> Other <br />