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I{, <br /> F r <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont.) Date: <br /> PROJECT NA <br /> --, ME• WELL NUMBER: <br /> PROJECT NUMBER:_ �C PERSONNEL: <br /> SAMPLE DATA: <br /> TIME SAMPLED- <br /> - <br /> DEPTH SAMPLED(It): <br /> � r <br /> SAMPLING EQUIPMENT: J1L£{� <br /> COMMENTS: .- <br /> Iv - <br /> > vaulwE ;.:s►IuaED!lleoEa> "AHALTSis <br /> CONZrUNER ;aELA .. - ,,•. <br /> COflTAINERS 1YVE MIESERYATIVE MLW TURSIOM COLOR CIWNOFti}STOOy REOUE97 :.' C0111AEfifS <br /> .:. �. .. FU.TRATWIi "AT�i'GZY . <br /> PURGE WATER DISPOSAL NOTES <br /> TOTAL DISCHARGE(gai): <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)NOLUME: <br /> COMMENTS: <br /> WELL.HEAT]CONDITIONS CHECKLIST(Circle YES or NO--if NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID, ASING LID AND LOCK)?: DES NO <br /> INSIDE OF WELL HEADPAR OUTER CASING DRY?: NO <br /> WELL CASING OK?: ES NO ��1✓// <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS: / JNA} <br /> TEMPERATURE(specify°CrF):-- _ (QC) 'F <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS: <br /> . c.c. Project Manager: <br /> Job Fife: <br /> Olher: <br />