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GROUNDWATER PURGE AND SAMPLE FORM (cont,) Date. <br /> PROJECT NAME. 6XX2'(\ - 394 z` WELL NUMBER- P <br /> PROJECT NUMBER' SDOQ 7' �Z�' r 4PERSONNEL- . XL Mw <br /> SAMPLE DATA: <br /> TIME SAMPLED (�S <br /> DEPTH SAMPLED (ft) ._ ':' S -I�"`' -- <br /> SAMPLING EQUIPMENT <br /> Tom^ c,�xr �e i�c��ier <br /> COMMENTS <br /> "140 : <br /> O OF CONTAINER RUM VOLUME SHIPPED UNDER ANALYSIS <br /> AINERS TYPE PRESERVATIVE fiLTAATIOH AlI TUABIOITY COLOR CNAIKOFCUSTODY REQUEST 'cobAltmm <br /> j /} (ad-� AT<-C(Y" (METHOD) <br /> 3 11 D A N CX / �' <br /> I J <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal) <br /> DISPOSAL METHOD. �5 CoYt c{rctm <br /> DRUM DESIGNATION(S)/VOLUME: CA 1-a�Q1 <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)?: yES� NO <br /> INSIDE OF WELL HEAD AW OUTER CASING DRY?: NO <br /> WELL CASING OK?: NO <br /> COMMENTS <br /> GENERAL <br /> WEATHER CONDITIONS -1 .G✓ <br /> TEMPERATURE(specify oc F) as'` 0OF <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? /tCrr� <br /> COMMENTS �- <br /> c c_ Project Manager <br /> Jots Fele <br /> Other _ <br />