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Date: 'JN"tY <br /> GROUNDWATER PURGE AND SAMPLE FORM (Cont.) <br /> *-' F <br /> PROJECT NAME r WELL NUMBER: <br /> PROJECT NUMBER: = PERSONNEL: L :�A� <br /> SAMPLE DATA: <br /> TIME SAMPLED- <br /> DEPTH SAMPLED(It): <br /> SAMPLING EQUIPMENT: — <br /> COMMENTS: At 4 ,11 <br /> a VOIUYE S "%p UWER AMx1,Y <br /> SAI PI$ �10►OFtx Cl71fTA1NEN liEtO <br /> v senvNrw �o memo cdra <br /> ow w ofmircor R€ouEsr <br /> t10 GOKTAtNERS 1lPE flL*A710N <br /> PURGE WATER DISPOSAL NOTES: <br /> .� TOTAL DISCHARGE(gad: - <br /> DISPOSAL METHOD: v <br /> DFUM DESIGNATION(S)/VOLUME: --- <br /> COMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--if NO,add comments) • <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY CASING LID AND LOCK)?: ES NO <br /> INSIDE OF WELL HEADAbkD OUTER CASING DRY?: YES NO <br /> WELL CASING OK?: YE NO <br /> COMMENTS: <br /> L VVI <br /> m j L�� <br /> GENERAL <br /> WEATHER CONDITIONS: P+d F 5�1 N <br /> TEMPERATURE(specify°CrF): lcz:> <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? 0 tj <br /> COMMENTS: <br /> .j C.C. P:oiect Manager: -- <br /> Job File: <br /> • Omer: - - - - <br />