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n �n -� K <br /> loan: <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont.) '{��- —� <br /> PROJILCT'NAME: t- Yjkg t ) WELL NUMBER: IVl Z J <br /> PROJECT NUMBER: 5�0 PERSONNEL: <br /> SAMPLE DATA: <br /> TIME SAMPLED: <br /> DEPTH SAMPLED(ft): <br /> -------------------------- <br /> SAMPLING EOUIPM& - �► ,.Ie�L. <br /> COMMENTS: <br /> SAMPLE Na OF CONTAINER -: Fi ELA ': VOLUME - - SSaPPEO UNGER `?i'AIu1.Y9S <br /> FFF PRESERYAT7V� - FILLED.: 7VAENDITY COLOR CHAINOFcusiroOY COUNENTS �' <br /> NO, CONTA,NCRS TYPE TILTRAT,ON AT<•C�YlN) ":''�1AETf106} <br /> ' �� 2 3 �t3� �-�CL. f•�u�-. L�,rt �tc� btz.� � - <br /> I� IM <br /> i. , <br /> PURGE WATER DISPOSAL_NOTES: <br /> TOTAL..DISCHARGE(gal): : ..Z AL•C ' <br /> .. <br /> :.DISPOSAL METHOD: S�'. <br /> 1 DRUM DESIGNATION(S)NOLUME: <br /> COMMENTS: <br /> I WELL HEAD CONDITIONS CHECKLIST(CirCIC YES or NO--it NO,add Comments) i <br /> I <br /> WELL SECt1FtITY.DEVICES OK(BOLLARDS,CHRISTY LID;CAS;?,c;LID AND LOCK)? } NO <br /> C/ <br /> x INSIDE OF WELL HEAD D OUTER CASING DRY?: �S NO <br /> WELL CASING OK?: f�E NO t <br /> COMMENTS: <br /> GENERAL- <br /> WEATHER CONDITIONS: SuNeu mJ j <br /> TEMPERATURE(specify oCrF):` <br /> a PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? Fl ti.s� z <br /> `.COMMENTS: <br /> t, k 4pi <br /> C.C. Project.Managei:' r <br /> Job File: <br /> Other: <br /> r <br /> i S <br /> A <br />