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S.[Yw 4 <br /> Gr&jrxtwater purge and Samplorm Date: / / Itnedy/Jenks Consukants <br /> V"jPROJECT NAME: -/�P-iWELL NUMBER: Ile�--2 <br /> �'' : <br /> •r•y <br /> PROJECT NUMBER: ,Y'_57y0 dC) PERSONNEL: <br /> SAMPLE DATA: <br /> TIME SAMPLED: COMMENTS: <br /> c <br /> DEPTH SAMPLED (FT): <br /> SAMPLING EQUIPMENT: <br /> N0. 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) COJMIENTS <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE (GAL): COMMENTS: <br /> DISPOSAL METHOD: Lrel-I �Ss� <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)?: YE NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?: NO <br /> WELL CASING OK?: � NO <br /> COMMENTS: <br /> GENERAL: <br /> WEATHER CONDITIONS: <br /> TEMPERATURE (SPECIFY 'C OR °F): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> ` cc: Project Manager: <br /> Job File: <br /> Other: <br /> ' ':. F-43.2(5-89) Page 2 of 2 <br />