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GROUNDWATER PURGE AND SAMPLE FORM (cont.) Dale- <br /> PROJECT NAME L?r,-,!!�� 7"L3J`yZ WELL NUMBER <br /> PROJECT NUMBER-&'11Z y� <br /> /7 PERSONNEL- ISL Iry <br /> SAMPLE DATA: . <br />' TIME SAMPLED <br /> DEPTH SAMPLED (ft) <br />' SAMPLING EQUIPMENT Tr-Ir-'Xin 3!7,dc Y` - �— <br /> COMMENTS Y6'4-" - <br />' <br /> SAMPLENOCONTAINER PRFSERYATlYE RVOLUME SWPPEDUNDER ANALYSIS <br /> NOOCONTAINERS: TYPE FILTRATION <br /> ��n FILLED TURBIDITY COLOR CNAMOFCYISTOOY REQUEST ,.Icom ENT9 <br />' (mlorq AT<C(Y" (METHM <br /> �Z 3 �G (31�y )/z;S -rf f,� <br />' PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE (gal)_ _ _ <br /> DISPOSAL METHOD <br /> DRUM DESIGNATION(S)/VOLUME- Z-A;t <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)'? Y NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY? NO <br /> WELL CASING OKE NO <br /> COMMENTS <br /> GENERAL <br />' WEATHER CONDITIONS <br /> TEMPERATURE(specify 0C10F) ig;�p G W <br />' PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING��e--7 _ <br /> COMMENTS f1l <br /> cc Project Manager <br />' Job File <br /> Other <br /> I <br />