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' GROUNDWATER PURGE AND SAMPLE FORM (coat_) Date <br /> PROJECT NAME_ 5 7" WELL NUMBER' <br /> VT NUMBER:�w/7 PERSONNEL: 4,0- <br /> SAMPLE <br /> SAMPLE DATA: <br /> TIME SAMPLED <br /> DEPTH SAMPLED (ft) <br />' SAMPLING EQUIPMENT �z <br /> COMMENTS /v2f <br /> SAMPLE NO OF CONTAINER VOLUME SNWPED UNDER ANALYSIS <br /> NO CONTAINERS TYPE PRESEAVAiIYE RLTRATION FILLED TURBIDITY COLOR CNAINOFCUSTODY REQUEST COMMENTS <br />' tmI ar I) AT 4-C(Y!!-0. (METHOD) <br /> r� <br /> 1 <br /> PURGE WATER DISPOSAL NOTES. <br /> TOTAL DISCHARGE (gal) <br /> DISPOSAL METHOD <br /> DRUM DESIGNATIONS)/VOLUME zw <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 AN NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRYI ES NCY— <br /> WELL CASING OK7_ 0 <br /> COMMENTS <br /> GENERAL <br /> WEATHER CONDITIONS <br /> TEMPERATURE (specify°C/OF) d' <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? / <br /> COMMENTS <br /> c c Project Manager <br /> Job File <br /> Ocher <br />