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�( <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont_) Date SZ <br /> PROJECT NAME- 6)�Xon -7 39 4 2_ WELL NUMBER- 19Z <br /> PROJECT NUMBER. 50007- PERSONNEL: /M w <br /> SAMPLE DATA: <br /> TIME SAMPLED IIS-0 <br /> DEPTH SAMPLE© (ft) - a, -- -- - - -- <br /> SAMPLING EQUIPMENT Too' <br /> COMMENTS- <br /> SAMPLE NO of C DNTAINERR£L p Yoww SHt4�EO UNINER ANALYSIS <br /> HO CONTAIfiERS SPE PRESERVAUVE FiLFIRMpN "it WRWQM CALOR CHA)NOFCIISTOQY REQUEST OORlWKFS <br /> (mf of I) AT 4`C(YAQ (METHGO) <br /> z 3 IPDA u(k ,/ 4of=C. I C )4s TP4-i ,s ri�-ri7x- <br /> --------------- <br /> PURGE WATER DISPOSAL,NOTES: <br /> TOTAL DISCHARGE(gal)- <br /> DISPOSAL METHOD: .. . --------------r-�-----ca,�La�e ArLttv% <br /> DRUM DESIGNATION(S)NOLUME- €-A Lolw-N <br /> COMMENTS- -- <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--it NO, add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID,CASING LID AND LOCK)?: ME NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?: ES NO <br /> WELL CASING OK?' NO <br /> COMMENTS <br /> GENERAL <br /> WEATHER CONDITIONS <br /> TEMPERATURE(specify-C/-F)- <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS rw-,l e- <br /> c.c_ Project Manager <br /> Job File <br /> Other <br />