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' GROUNDWATER PURGE AND SAMPLE FORMcont. Date. <br /> PROJECT NAME L 7-� FORM ( <br /> WELL NUMBER- <br /> PROJECT NUMBER PERSONNEL- w <br /> ' SAMPLE DATA. <br /> TIME SAMPLED 12- <br /> DEPTH <br /> ZDEPTH SAMPLED (h) <br /> ' .37X r- <br /> SAMPLING EQUIPMENT 7241,Fn j--3j2 <br /> COMMENTS —f-.- <br /> SAMPLE NO OF CONTAINER RE nn VOLUME StAPPEO UFIOEA ANAlT5t5 <br />' <br /> NO CONTAINERS TYPE PRESERVATIVE FILLED TURGIDITY COLOR tNJUNOFGUSTOOY REQUEST RLTRATION CO/�AAIEN;'S <br /> [mI or Iy A7 4-C(Y/FQ (L{ETHOO} <br /> PURGE WATER DISPOSAL NOTES <br /> TOTAL DISCHARGE (gal) <br /> DISPOSAL METHOD <br /> DRUM DESIGNATION(S)/VOLUMEi� <br /> COMMENTS <br /> WELL HEAD CONDITIONS CHECKLIST (Circle YES or NO-- it NO, add comments) <br /> WELL SECURITY DEVICES OK (BOLLARDS, CHRISTY LID, CASING LID AND LOCK)"� <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY NO NO <br /> WELL CASING OKE� NO <br /> COMMENTS /l/ <br /> GENERAL <br /> WEATHER CONDITIONS C� p <br /> TEMPERATURE (specify DCrF) O <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING" <br /> COMMENTS <br /> t <br /> cc Project Manager <br /> Job File <br /> Other f <br />