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�" _ <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont.) Date. 3" `��- <br /> PROJECT NAME- 2- 39142— WELL NUMBER. OZW4 <br /> PROJECTNUMBER 80007-?-9• l4($ PERSONNEL- YL Mw <br /> i <br /> SAMPLE DATA- <br /> TIME SAMPLED <br /> DEPTH SAMPLED (ft) -- <br /> SAMPLING EQUIPMENT <br /> COMMENTS <br /> SAMPLE NOCONTAINER REW <br /> VOLUME StdPPED TINDER ANALYSIS <br /> NO CONTAIN <br /> ERS TVP€ PRESERVATIVE i�LTRATION TiLLFD TURGIDITY COLOR CHAIN OF CUSTODY REQUEST CGMUENTSi <br /> (m1 or q AT{`C(YRQ ("ETHOD) <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE (gal) <br /> DISPOSAL METHOD <br /> DRUM DESIGNATIONS)/VOLUME FA <br /> COMMENTS <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)? NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY? NO <br /> WELL CASING OK'2: NO <br /> COMMENTS ✓ <br /> GENERAL. <br /> WEATHER CONDITIONS <br /> TEMPERATURE(specify-crF) 65'--9 01 <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLINGI 11ov� <br /> COMMENTS <br /> c_c Protect Manager <br /> Job Fite <br /> Other <br />