Laserfiche WebLink
GROUNDWATER PURGE AND SAMPLE FORM (cont.) Date- <br /> PROJECT NAME G 7"3 WELL NUMBER <br /> PROJECT NUMBER 10� ylg' PERSONNEL- 14 L kW PC- <br /> SAMPLE <br /> SAMPLE DATA. -' <br /> TIME SAMPLED__12_2-6 <br /> DEPTH SAMPLED (ft) ym J--Y— <br />' SAMPLING EQUIPMENT - <br /> COMMENTS <br />' VOLUME S"PPEO UHDER ANALYSIS <br /> SAMPLE NO OF CONTAINER RFLO <br /> No CONTAINERS TYPE PRFSFAYATfVE RLTRATION Til-L'ED TURBIgTY COLOR C11AIh O-C(Y" UY REGUMT <br /> THM Co#It,AEHiS <br />' (ml op AT 4`G iY!!q (KETNOai <br /> �1 3 yoa-, M-ee <br /> 1 <br />' PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE (gal) <br /> DISPOSAL METHOD <br /> DRUM DESIGNATION(S)NOLUME �✓� <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 WELLHEAD AND OUTER CASING DRY�(�.E- NO <br />' WELL CASING OK? NO <br /> COMMENTS <br /> I <br /> GENERAL <br />' WEATHER CONDITIONS D e✓ rr <br /> TEMPERATURE (specify 06 F) S�©' <br />' PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING <br /> COMMENTS tl� <br /> c c Project Manager <br /> Joh File <br /> Other <br />