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ski.+ <br /> # '� C iact• t d iy, i$r �` i <br /> Date: <br /> GROUNDWATER PURGE AND SAMPLE C=ORM (coni.) — - <br /> vxor7 1- 361/1z-, Wt_l..L NUMBER: F W t <br /> PROJECT NAME:.--- <br /> � <br /> PROJECT NUMBER:-102 L1(O _� _.-. _ PERSONNEL: <br /> SAMPLE DATA: <br /> TIME SAMPLED:—_—1-7-i------ <br /> DE-11771 SAMPLED(ft):_____-Ai�._ <br /> SAMPLING I:QUII'MENT; .ls <br /> COMMENTS: <br /> YollluY: 51tl PI'EP UNDEII ANhLYSIS <br /> SAMPLr NO,Or cOIII/JNr11 Fit 19 <br /> N0- CONTAIFILRii TYPE PliliTllYA 71YL' IILTIIAIION Ii(LI.l1 IUIIIAMY COLON CNWNOFCUST00Y WOUEST C04AUENTG- <br /> (miarq AT 4-C(Y." (Lir:M001 - <br /> 1y�1E-^ �- <br /> PURGE WATER DISPOSAL NOTES: _ <br /> TOTAL DISCHARGE(gal): — <br /> DISPOSAL METHOD:_ r +ntl� <br /> DRUM DESIGNATION(S)1VOLUME: -- <br /> COMMENTS:_. <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO if NO,add comments) <br /> WELLSECURITY DEVICES OK(BOLLARDS,CHRISTY LID,CASING LID AND LOCK)?: Y[ NO <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: 1:E7S NO <br /> WELL CASING OK?: Y�ES7 NO <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS— <br /> TEMPERATURE(specify <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? Y?on if_ <br /> COMMENTS: <br /> c.c. Project Manager- -- <br /> Job Fife: <br /> Other: — <br />