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Groundwater Purge and SamWe Form Date "3c, _�2 Kennedy/Jenks/Chilton <br /> PROJECT NAME- CA I -Jay d �a,�l.}�H WELL NUMBER. I b 7_3 <br /> PROJECT NUMBER: PERSONNEL - ell r <br /> • <br /> SAMPLE DATA: <br /> TIME SAMPLED 10 PM COMMENTS- <br /> DEPTH SAMPLED (FT)- <br /> SAMPLING EQUIPMENT: <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 /> X5 <br /> PURGE WATER DISPOSAL NOTES: �%}} ,f� � .—.— • <br /> TOTAL DISCHARGE (GAL) •N a�r COMMENTS• <br /> DISPOSAL METHOD <br /> DRUM DESIGNATIONS)/VOLUME PER (GAL) <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)7• YES NO Nev,?L M e-L� <br /> �I{LL 5 4� <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?- YE5 NO --�' <br /> WELL CASING OK7• ES NO <br /> COMMENTS 4' GC+M <br /> GENERAL: �{ c <br /> WEATHER CONDITIONS Y1 d `L.ixiti <br /> TEMPERATURE (SPECIFY °C OR °F) 76 &Z) <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? 1 t-c— <br /> cc. Project Manager Ke&e_ PL hy]e <br /> Job File: <br /> Other. <br /> F432(488) Page 2 of 2 <br />