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VON <br /> S <br /> J Dale: <br /> ----- GROUNDWATL-13 PURGE AND SAMPLE_ FORM (cont.) <br /> PROJECT NAME: /-- _= /_/_ WELL NUMl9rR: <br /> PROJECT NUMBER:-ye <br /> SAMPLE DATA: /TIME -- <br /> DEPTI-1 SAMPLED -- <br /> a <br /> SAMPLING EQUIPMENT: ---- <br /> COMMENTS: --- — <br /> -- - �- <br /> -- VOUI�C - u7t['1'CO U;r0CN ANALY_j'T CO7aI4CITr4 <br /> FILLo <br /> SAGI'LC NO.Of COIITAINCI[ I'FIL:LNVAi1V[ 17LT IiAT1ON Iru'L lViI1S:D1tY COLOR CIIIAYO cG{Y�-y {CWlliOp1 <br /> }{0. CONTAINCN6 TYPO - <br /> x�= <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal): <br /> DISPOSAL.METHOD:— <br /> DRUM <br /> ETHOD:DRUM DESIGNATION(S)/VOLUMIr: � ��' <br /> COMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO if NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRIS TY CASING LID AND LOCK)?: ES NO <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: YES, NO <br /> WELL CASING OK?: ESi NO <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS: <br /> TEMPERATURE(specify'C/°F): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS: <br /> c.c. Project Manager_ <br /> Jab File: <br /> Other: <br />