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GROUNDWATER PURGE AND SAMPLE FORM (cont.) Date' 30 92 <br /> PROJECT NAME ESC°n -7- 311'4L WELL NUMBER: 0 <br /> PROJECT NUMBER_ $0007'Z9- 14(o8 PERSONNEL: _ KL -/M w <br /> SAMPLE DATA- <br /> TIME SAMPLED ZZO <br /> DEPTH SAMPLED (ft) <br /> SAMPLING EQUIPMENT 5-oxekIe bn'ie r <br /> COMMENTS- ' <br /> 5 <br /> SAYPL.E NO.OF CONTAINERiiEL!? VOLME fA4PPEOUNDER ANALYSIS <br /> NO CQNTAINERS TYPE PIIFSEHYATIVE F11_TRATION i FILLED TUR61DrIY COLOR CFIAINOFCIFSToDY REQUEST <br /> / (m1 Of 1) r( AT f'C(Y?q (WET"00) <br /> 3 VOA Wk / �_'� �I]LcC bre yes TPS Jas �tfc7r <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL. DISCHARGE (gal) <br /> DISPOSAL METHOD. <br /> DRUM DESIGNATION(S)/VOLUME- EA La!�,e1 <br /> COMMENTS. <br /> r <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 WELLHEAD AND OUTER CASING DRY?,� NO <br /> WELL CASING OK?. NO <br /> COMMENTS -� <br /> GENERAL <br /> WEATHER CONDITIONS <br /> TEMPERATURE(specify <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? �2t'tca— <br /> COMMENTS <br /> C c- Project Manager <br /> .lob File � <br /> Other <br />