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J �I 1 <br /> Palo: C_r��__ <br /> ---- GROUNDWATER PURGE AND SAMPLE FORM (cont.) <br /> PROJECT NAME: G�'�a'� WELL NUMBER: --- --- <br /> } t I C� . I�- PERSONNEL:— r'' -1 Lt } <br /> PROJE=CT NUMBER: � " fi <br /> SAMPLE DATA: ] L{ LI S TIME SAMPLED: <br /> DEPTH SAMPLED(It):_. <br /> SAMPLING EQUIPMENT: --~— <br /> COMMENTS: <br /> YOLUl1E SItlPP2p UNDERANALYSIS. . <br /> 'COLI}AENY$ <br /> SAMPLE - 140.Of COMM."Ea oRCSERYATIVE FILTRATION 7h..LO-ILD nLLW TURINOITY COLOR CNAINOFCUSTOOY R6oUEST: <br /> NO. cO"TUNERS -,.ME <br /> (ml or l� - -AT a-C(Y" (MiTI+O0! <br /> I�,7 XF <br /> i`WO 3 �10A HC- 1 <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal) <br /> DISPOSAL METHOD: SS ``�I t�r" <br /> DRUM DESIGNATION(S)/VOLUME- C% L abs <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 s OCK)?: YES'3 NO <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: S NO <br /> WELL CASING OK?. 6E§D NO <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS- rr ^ <br /> TEMPERATURE(specify°C/°F): F- <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? ✓�,v+ — <br /> COMMENTS: <br /> c.c. Pro]ec! Manager: <br /> Job File: <br /> Other: <br />