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u <br /> w <br /> } Date: <br /> -- GROUNDWAZ'r-k PURGE- AND SAMPLE F08M (cont.) <br /> PROJECT NAME: J� WELL NUMBER:--- <br /> FROJECT NUMBER:_-e1 XC_"A/ "=PERSONNEL: <br /> SAMPLE DATA: <br /> TIME SAMPLED: – <br /> DEPTH SAMPLED(II):_ �- <br /> SAMPLING EQUIPENT: � '-1—`�� '� L <br /> M — <br /> C()MMENTS: — <br /> .. - vC/}l AiEUNDEf[ <br /> IMA LYS[S coiAueNrs , <br /> SALIPLE Mo,OF CCMTAIMER priT:+EIIVATIYE nru) .. nLLLD T61NDITY COLOR. Ci WH OF':JJST0nY AcoDP.ti7 <br /> .NO, COIiTAIMLRs •T%Pi.:. D FiLTRATIOM '(mlwl) ATC';(Yfty' IPETFIOD) _ "• <br /> Aglg °�`� T Ems` <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGLE(gat): ---------- <br /> DISPOSAL METHOD: <br /> DISPOSALMETHOD: <br /> D,`ILIM DESIGNATION(S)f 0LUME: <br /> COMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO -it NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY L1D CASING LID AND LOCK)?: YE NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?: � NO <br /> WELL CASING OK?: OE ) NO <br /> COMMENTS:__ _— <br /> GENERAL <br /> WEATHER CONDITIONS: <br /> TEMPERATURE(specify°CI°F): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS: f' <br /> 1 _ <br /> c.c. Project Manager. �--•— <br /> Job File: <br /> Other_ <br />