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GROUNDWATER PURGE AND SAMPLE FORM (coat.) Date: T� Gds, <br /> PROJECT NAME• w / �� BO WELL NUMBER: <br /> PROJECT NUM13ER: In O5 — PERSONNEL: <br /> SAMPLE DATA: <br /> TIME SAMPLED- <br /> DEPTH SAMPLED(ft): <br /> SAMPLING EQUIPMENT: <br /> COMMENTS: <br /> NR CF:., COH�AINEp <br /> ME <br /> pip VOLU513VPEd uNDEA AIi4LYSiS <br /> PBESERYATWE <br /> CCfITAlNERS TYPE RLTAl1T{pli lilLED lURdIGlTY COIOR CWITNbFCi1SCOOY : -:'tMFST "CCIdIdENTS :: ::- <br /> �° �1. ..>• ;... �:Ai��C'[17NI, > `paEY11oo1 <br /> 41t 695;Ab2o <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal): <br /> DISPOSAL METHOD:_ <br /> DRUM DtcSIGNATION(S)NOLUME: <br /> COMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--it NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS, CHRISTY ASING LID AND LOCK)?: YES NO <br /> INSIDE OF WELL HE OUTER CASING DRY? YES NO <br /> WELL CASING OK?: YE NO <br /> COMMENTS: <br /> GENERAL r�, <br /> WEATHER CONDITIONS: <br /> TEMPERATURE(specify°C1°17): <br /> PROBLEMS ENCC►:JNTEAED DURING PURGING OR SAMPLING? /JC <br /> COMMENTS: ( �� <br /> c.c. Project Manager: ~' - <br /> Job File: <br /> Other, <br />