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it�..-� <br /> R. <br /> Dal, <br /> -- GROUNDWATER PURGE AND SAMPLE FORM (cont.) <br /> PROJECT NAME:_ E�xXo`', '- _- _WCLf.NUMBER: _ <br /> 7 LLQ <br /> 1 <br /> PROJECT NUMBER:__I O 1_it� _ I � _ PEIISONNEL:__.._ <br /> SAMPLE DATA: <br /> TIME SAMPLED: <br /> DEPTFI SAtAPLED(ft):_ -- <br /> SAMPLING EQUIPMENT; C4jjz'_. Iter -- <br /> COMMENTS: — — <br /> I'lE ND.OF COFI YA1NEf1 - VOLUME Sffl'1'ED UNDEN AUALYS15 <br /> SAM <br /> NO. CO040. :fiS .'YYPE., PF16ERVATIVE nEl9 IILLCU 7VITI��:::� �oLo" CI(AINOFCUSIOOY nc(x)c9Y COMMENTS <br /> 71URA11014 {n1 or 11 At VC(Y" (METHOD) <br /> _ — P,T ZC <br /> (?W2 '3 V06 OCE l" fid-[' Low C(!' yeg -rio),) c)as <br /> PURGE=WATER DISPOSAL NOTEZ: <br /> TOTAL DISCHARGE(gal). <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)IVOLUME:_ <br /> COMMENTS: <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)?: YES NO <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: 6E__J NO <br /> WELL CASING OK?: ES NO <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS: c`Jnr <br /> TEMPERATURE(specify'C/'F): <br /> PROBLEMS ENCOUNTERED DURING PURGING Oti SAMPLING? <br /> COMMENTS: <br /> c.c. Project Managor <br /> .lob File: <br /> Other: <br />