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Groundwater Purge and Sample Form Date l5 9 <br /> PROJECT NAME /=Z f5Cf`VY" :. IUIO�►1 ��' �_ WELL NUMBER' 1`'-\!✓` <br /> PROJECT NUMBER- PERSONNEL: M <br /> • <br /> _SAMPLE DATA <br /> TIME SAMPLED. 12 2;:t-2 COMMENTS. <br /> DEPTH SAMPLED (FT): 2 <br /> SAMPLING EQUIPMENT. 5 0sc, <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 /> PURGE WATER DISPOSAL NOTES. <br /> TOTAL DISCHARGE-(GAL). I� COMMENTS.— <br /> DISPOSAL METHOD D n/ <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)?. E NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY? NO <br /> WELL CASING OK? �gS NO <br /> COMMENTS <br /> GENERAL. <br /> WEATHER CONDITIONS G(-e4, <br /> TEMPERATURE (SPECIFY °C OR °F) 0 <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING N2 0 <br /> cc Project Manager. 6)CA^� �►� �-� �� 0 V% <br /> Job File. <br /> Other- <br /> F 432(5 89) Page 2 of 2 <br />