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' u��"M �� �` S fi_ d r Y i��.5r, � -•-jiff � !{,r - ' �, t' , � ° � k <br /> Dato' <br /> GROUNDWATER PURGE AND SAMPLE FORM {cont.) <br /> r XXo,�11�._..WGI.L <br /> PROJECT NAME:.-.-- -- —"— <br /> All <br /> ti ) <br /> — PERSONNEL:---- <br /> PROJECT <br /> _ <br /> PROJECT NUMBER: o - <br /> SAMPLE <br /> �—' <br /> DATA: 1310 <br /> TIME SAMPLED: <br /> DEPTH SAMPLED(It):-� � <br /> SAMPLING EQUIPMENT: �e — ��'�'---- - -- <br /> COMMENTS: — ----�—.-�— <br /> — -- <br /> —�— A4ALYSIs . <br /> _ VOIUYE 51 atf'PEP tlNtlLR WCAKST - CQIANCIiIS <br /> C0MAINE11 FIELD FILLEO TURIN p[Y COltlR CIWfi OI�CIISTPOY (1IET110tlf <br /> SAf O. T OF PRE;ERYATIYE FiLTRAFION fml-li AT 4'C IY+Ni —" <br /> NO. CO117N1;EI;5 TYPE __ _ –_— <br /> ful aVOA 110 - <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal), <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATEON(S)NOLUME. _ <br /> COMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--it NO,add comments) <br /> WELL SECURITY DEVICES OK(SOLPARDS,CHRISTY LID,CASING LID AND LOCK)?: NO <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: (20 NO <br /> WELL CASING OK?: (6�) NO <br /> COMMENTS: <br /> GENERAL jU�O I/ <br /> WEATHER CONDITIONS:_ <br /> TEMPERATURE.(spc-city°CrF): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING. <br /> COMMENTS: <br /> C.c. Project Manager. <br /> Jab File: — <br /> Other: — <br />