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001 <br /> f - <br /> Data: Qidpo <br /> GROUNDWATER PURGE AND SAMPLE. FORM (cont.) j <br /> 'PROJECT NAME:--g&-ON - %Csv WELL NUMBER: <br /> PROJECT NUMBER: )UZ��• ly PERSONNEL: '�s - { <br /> SAMPLE DATA: <br /> TIME SAMPLED: (05 5-- <br /> DEPTH SAMPLED(It): <br /> SAMPLING EQUIPMENT: � - <br /> COMMENTS. �- <br /> ' YALUuE''- V9PPEDUNDER 'ANAl,Y9S r:-y <br /> SAYPLF. .N0.0F '-' GANT,AfNER - 'a flEtA ... <br /> pRESERYATIYE RLLED' TUE6IDIT7 COLOR CH.IIHOFCUS70DY REQticST CAIdMENTS . <br /> NO. COWAIHERS TYPE ,.:- -. Fl i.RATIC!! ?] ,.'ATCC(YRq <br /> ... >:. - <br /> 90 <br /> i <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE,gaq: <br /> DISPOSAL MET•t-IOD:- $ <br /> DRUM DEIGNAT.ION(S)NOLUME: LAD <br /> �� " <br /> COMMENTS: <br /> t <br /> I <br /> WELL HEAD CONDITIONS CHECK! ST(Circle YES or NO--it NO,add comments) <br /> WELL SECURITY DEVICES OK(SOLU ADS,CHRISTY LID,CAS-?4G LID AND LOCK)?: � NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?: NO 'F <br /> WELL CASING OK?: } 5, NO <br /> I COMMENTS: <br /> GENERA <br /> L <br /> WEATHEF, CONDITIONS: <br /> TEMPERATURE(specify OC/'F): o <br /> L 'r PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? - <br /> r <br /> COMMENTS: <br /> E <br /> I' <br /> $ c.c.: Project Manager: *` <br /> l <br /> Job Filo: <br /> Other: <br /> 9M <br /> .ISI <br /> " t <br />