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GROUNDWATER PURGE AND SAMPLE FORM (cont.) Date. <br /> PROJECT NAME: Gr— WELL NUMBER.__LW. 2— <br /> PROJECT NUMBER PERSONNEL- 141— hjw <br /> SAMPLE DATA: <br /> TIME SAMPLED 1:5 7-6;' <br /> DEPTH SAMPLED (ft) A _� . <br /> i SAMPLING EQUIPMENT <br /> COMMENTS /1�viy <br /> SAMPLE NO OF CONTAINER 13ELD YdIUYE 57tlPPED IfNOvR ANALYSIS <br /> NO CONTAINERS TYPE PRESERVATIVE RLTRATiON RLLED TURIMOITY COLOR CIWNOFC'IfSTODY BEQUEST 'COMMENTS <br /> (w«1) AT PC(Y" (METHOD) <br /> 12 u 3 vas 6f�� N� 11° M� ' `� �5 �q--pag45 <br /> m 1 FS T"1- <br /> i <br /> PURGE WATER DISPOSAL NOTES <br /> TOTAL DISCHARGE (gal) <br /> DISPOSAL METHOD � Z:2,.,,„7 — <br /> DRUM 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 LID, CASING LID AND LOCK)? ES NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY? � NO <br /> WELL,CASING OK? i� NO <br /> COMMENTS <br /> GENERAL <br /> WEATHER CONDITIONS der czs Z' <br /> TEMPERATURE(specify°C/OF) D� <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS <br /> cc Project Manager <br /> .lob File <br /> Other <br />