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i <br /> Groundwater Purge and Sample Form Date q DEC 93 Kennedy/Jenks Consultants <br /> PROJECT NAME 1�ar� WELL NUMBER. sy W-1 <br /> ECT NUMBER• %Z25 4 D -00 PERSONNEL: �• A+Aur, <br /> SAMPLE DATA <br /> TIME SAMPLED ,2 4 Zi COMMENTS. <br /> DEPTH SAMPLED (FT) 1 7 <br /> SAMPLING EQUIPMENT. &.JpD <br /> i <br /> NO OF CON- FIELD VOLUME SHIPPED UNDER ANALYSIS <br /> SAMPLE CONTAIN- TAINER PRESER- FILTRA- FILLED CHAIN-OF-CUS- REQUEST <br /> NO ERS TYPE VATIVE TION (ml or L) TURBIDITY COLOR TODY AT 4°C7 (METHOD) COMMENTS <br /> J so,s w6t CO AedeR . _ <br /> GE WATER DISPOSAL NOTES <br /> OTAL DISCHARGE (GAL) — .S___q2rA_ COMMENTS: Pei�oh WIZIer 61 1 <br /> DISPOSAL METHOD. AfLLW% �-i-Qegbed wi <br /> DRUM DESIGNATION(S) PER (GAL). lA, wa•TE <br /> WELL CONDITIONS CHECKLIST (CIRCLE YES OR NO - IF N0, ADD COMMENTS) <br /> WELL SECURITY DEVICES OK (BOLLARDS, CHRISTY LID, CASING LID AND LOCK)? YES NO <br /> INSIDE OF WELL BEAD AND OUTER CASING DRY?. bES NO - <br /> WELL CASING OK? CES) NO <br /> COMMENTS <br /> GENERAL <br /> WEATHER CONDITIONS CL0LJA &00\ <br /> !!__pp��o <br /> TEMPERATURE (SPECIFY °C OR °F) (a0 <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING <br /> cc Project Manager <br /> Job File <br /> Other. <br /> F 43 2(5 89) Page 2 of 2 <br />