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GROUNDWATER PURGE AND SAMPLE FORM (cont.) Date <br /> PROJECT NAME �X � 7'��y� WELL NUMBER: 81-j&/_ <br /> y <br /> PROJECT NUMBER A��y&' /F _ PERSONNEL-_ �� 1rlW, <br /> SAMPLE DATA- <br /> TIME SAMPLED <br /> DEPTH SAMPLED (ft) _,V -'� <br /> SAMPLING EQUIPMENT rx- <br /> COMMENTS <br /> SALPLE NO OF CONTAINER RELD VOLT ME StYPPED UNDER ANALYSIS <br /> NO. CONTAINERS TTP£ PRESERVATIVE FILTRATION }IU" TURBIDITY COLOR CNAINOFCUSTODY REQUEST CCWJAENTS <br /> (nd-4 ATI-C(Yj" (METROVI <br /> pav 3 t'a--t' #e'L '�'Jn' q40 qrt yrs 7-PH <br /> -H re-5 <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE (gal) p <br /> DISPOSAL METHOD <br /> DRUM DESIGNATION(S)/VOLUME 1-,4L <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 /> r <br /> GENERAL <br /> WEATHER CONDITIONS re sr- <br /> TEMPERATURE(specify*C/°E) f <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLINGI&-!� <br /> COMMENTS <br /> C <br /> c Project Manager <br /> Job File <br /> 01her <br />