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GROUNDWATER PURGE AND SAMPLE FORM (cont_) Date ti &OL9 z <br /> PROJECT NAME 6x^<dn 2- 3(1'4 Z- WELL NUMBER- MW l! <br /> PROJECTNUMBER xC007-Z9- 146:9 PERSONNEL- KL JMM) <br /> SAMPLE DATA: <br /> TIME SAMPLED 114w <br /> DEPTH SAMPLED (ft) <br /> SAMPLING EQUIPMENT !40^ r 'e- <br /> COMMENTS <br /> eCOMMENTS ki c-vIe <br /> SAMPLE NO OF CONTAINER PRESERVATIVE R VOLUME SWPPEO UNDER ANALYSIS <br /> NO CONTAINERS TYPE PRESERVATIVE FILTRATION ALLED TURBIDITY COLOR CNAINOFCUSTOOY REQUEST COMMEATS <br /> / (md of l) AT 4'C(YIN (uEntol) <br /> Wit 3 VoA CQ- lTP+4, �r.c 1 <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE (gal) 1 Z <br /> DISPOSAL METHOD. �5 Cove �rCldY► <br /> DRUM DESIGNATION(S)NOLUME. FA L 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)'? `fES O <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY? (YO NO <br /> WELL CASING OK? ES NO <br /> COMMENTS <br /> GENERAL <br /> WEATHER CONDITIONS Com' <br /> TEMPERATURE(specify°C/°F) <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? arie. <br /> COMMENTS h ani <br /> CC- Protect Manager <br /> .lob File <br /> Other <br />