Laserfiche WebLink
Groundwater Purge and Sample Form Date <br /> PROJECT NAME r-7 '--C (lko,,,, tc._ WELL NUMBER �ML✓` I� <br /> PROJECT NUMBER. PERSONNEL- '41 CX+^C G-) C P-1 vn k r-{ <br /> • <br /> SAMPLE DATA <br /> TIME SAMPLED: l7 COMMENTS: <br />——DEPTH-SAMPLED-(FT): _ <br />- - SAMPLING EQUIPMENT. ox - --- -- - - --- --- - - - - - - - ---- <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°C? (METHOD) COMMENTS <br /> w-(v V4 DELL- �— �(�' w,L ..�_ ' Y- Y-G5 IDIS `-� <br /> PURGE WATER DISPOSAL NOTES <br /> —TOTAL DISCHARGE-(GAL)- , '��c, ca COMMENTS: �— <br /> DISPOSAL METHOD: () s4 oyti.c, -e- <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)?. NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?. d3) NO <br /> WELL CASING OK? (5t NO <br /> COMMENTS <br /> GENERAL. <br /> WEATHER CONDITIONS G1 <br /> TEMPERATURE (SPECIFY °C OR T'7. <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING1 V <br /> cc. Project Manager. <br /> Joh File <br /> Other <br /> F 43 2(5 89) Page 2 Of 2 <br />