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Groundwater Purge and Sampprm Date: —LI-L— nedy/Jenks Consultants <br /> PROJECT NAME: WELL NUMBER: <br /> PROJECT NUMBER: PERSONNEL:. <br /> SAMPLE DATA: <br /> TIME SAMPLED: IO:O w COMMENTS: <br /> DEPTH SAMPLED (FT): <br /> SAMPLING EQUIPMENT: sp�y6�a <br /> NO. OF CON- FIELD VOLUME SHIPPED UNDER ANALYSIS <br /> SAMPLE CONTAIN- TAINER PRESER- FILTRA- FILLED CHAIN-OF-CUS- REQUEST <br /> /NO. ERS TYPE VATIVE TION (ml or L) TURBIDITY COLOR TODY AT 4°C? (METHOD) COMMENTS <br /> /VD <br /> ar<k <br /> PURGE WATER DISPOSAL NOTES: _ <br /> TOTAL DISCHARGE (GAL): 3 . 5 COMMENTS: <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)/VOLUME PER (GAL): <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)?: YES NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?: YES NO <br /> WELL CASING OK? YES NO <br /> COMMENTS: <br /> I <br /> L: <br /> HER CONDITIONS: Cj- /ERATURE (SPECIFY °C OR "F):LEMS ENCOUNTERED DURING PURGING OR SAMPLING?roject Manager: <br /> ob File: <br /> ther: <br /> 89) Page 2 of 2 <br />