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Groundwater Purge and Sample Form Date ��s_A <br /> PROJECT NAME. J'-Z `51-_ r-Ly. Ma �--c c_a WELL NUMBER. /tAL,/- <br /> PROJECT NUMBER• PERSONNEL: 7��c h.� Sc r-i rn S��1 -(-_ <br /> .SAMPLE DATA <br /> TIMr SAmPLED. COMMENTS <br />——DEPTH-SAMPLED-(FT): <br /> SAMPLING EQUIPMENT. <br /> OF CON- FIELD VOLUME SHIPPED UNDER ANALYSIS <br /> [;"OT. ERS <br /> TAIN- TAINER PRESER- FILTRA- FILLED CHAIN-OF-CUS- REQUEST <br /> TYPE VATIVE TION (mi or L) TURBIDITY COLOR TODY AT 4°C? (METHOD) COMMENTS <br /> S-e-'9-45, <br /> lvkvv-1 Ll VO4 46L HO vv\L leo-r el <br /> PURGE WATER DISPOSAL NOTES: ! <br /> —TOTAL-DISCHARGE-(GAL) —�-r,' c r COMMENTS: <br /> r <br /> DISPOSAL METHOD Dr,v w. G r <br /> DRUM DESIGNATION(S)/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)?. (!IEP NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?. q-3) NO <br /> WELL CASING OK? F NO <br /> COMMENTS <br /> GENERAL <br /> WEATHER CONDITIONS C 1 C <br /> TEMPERATURE (SPECIFY °C OR _ <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? Q 0 <br /> cc Project Manager ('�o�r-�. G�-w 4A u <br /> Job File <br /> Other <br /> F 43 2(5 89) Page 2 Of 2 <br />