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GROUNDWATER PURGE AND SAMPLE FORM (cont.) Date: <br /> PROJECT NAME: 7-3 `Zr- <br /> WELL NUMBER <br /> PROJECT NUMBER &7,2- � PERSONNEL: 1w w <br /> ' SAMPLE DATA: <br /> TIME SAMPLED / <br /> DEPTH SAMPLED (ft) 3�y <br /> SAMPLING EOUIPMENT Tr <br /> COMMENTS <br /> SAUPLE NO OF YOI.[IiA£ %4PP£O UNOEA ANALYSIS <br /> NO CONTAINERS TYPE PRESERVATIVE ftupwION FILLED TURBIDITY COLOR CRAINOFCUSTOOY REQUEST -,COLUAENTS <br /> (+w of Il AT 4-C(Y" (METHOD) <br /> !/-z' cp <br />' PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE (gal) <br /> DISPOSAL METHOD <br /> DRUM DESIGNATIONS)/VOLUME L4 <br /> COMMENTS , <br />' WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO-- if NO, add commerlts)s <br /> WELL SECURITY DEVICES OK(BOLLARDS, CHRISTY LID, CASING LID AND LOCK)Ic� NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRYS NO <br />' WELL CASING OK'kt!:7M>--NO- <br /> COMMENTS <br /> } <br /> GENERAL <br />' WEATHER CONDITIONS 6 <br /> TEMPERATURE (specify°C/°F) e <br />' PROBLEMS ENCOUNTeREQ DURING PURGING OR SAMPLING?,l/2-,9 <br /> COMMENTS <br /> C <br /> c Project Manager <br /> Jab File <br /> Other <br />