Laserfiche WebLink
GROUNDWATER PURGE AND SAMPLE FORM (Cont.) Date:-] <br /> PROJECT NAME7215 2, WELL NUMBER,_ <br />' PROJECT NUMBER-/AZ /� _ PERSONNEL'-J4 L <br /> SAMPLE DATA. <br /> TIME SAMPLED37,7 <br /> DEPTH SAMPLED (ft) <br /> SAMPLING EQUIPMENT- rr- <br /> COMMENTS <br /> SAMPLE NO of CONTAINER RELO VOLUME SHIPPED UNDER ANALYSIS <br /> NO CONTAINERS TYPE PHE�'ERVATIVE FILTRATION RLLFO TURBIDITY COLOR CHAINOFCUSTODY NEWEST t NTS <br /> (rN ar q AT{'C IY44 (WTHOD) <br /> PURGE WATER DISPOSAL NOTES- <br /> TOTAL DISCHARGE (gal)_� � <br /> DISPOSAL METHODll Tzr�.rr� <br /> DRUM DES IGNATION(S)/VOLUME_ - <br /> h 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)? YES NO <br /> INSIDE OF WELL HEAD AND OUTER CASING D NO <br />' WELL CASING OK?� NO <br /> COMMENTScr _g <br /> GENERAL -- — <br /> WEATHER CONDITIONS <br /> TEMPERATURE(specify°C/°F) 4' <br /> PROBLEMS ENCOUNTERED DURING PURG[NG OR SAMPLING?AeicQ <br /> - <br /> COMMENTS <br /> cc Project Manager <br /> Job File <br /> Other <br />