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y <br /> ti•^M <br /> SWA <br /> Date: I - 30 /O _ <br /> GROUNDWATEN PURGE AND SAMPLE FORM (cont.) <br /> PROJECT"NAME:_."e'01�� �- '� �--.-.-WELL NUMBER:-_ : "��% <br /> PROJECT NUMBER:— P f) "?'r(• 19---- PERSONNEL:--,_s R �V� <br /> SAMPLE DATA: <br /> TIME SAMPLED:—. ---- <br /> �� <br /> DEPTH SAMPLED <br /> SAMPLING EQUIPMENT:_.T' Ic raLiy..Y — <br /> COMMENTS <br /> SAYItiE he.or - COHTAlNCIt Lf1L1.11 <br /> Yd.UWI: 511PPIL)UNI.Lq AUALMS <br /> 'No. 40H TAINrR>+ TYPE: I�FIL3LSIYA iIYL � FU111T TL I:�iIIXTY ^.d.dl f.1WH OF CUGTWY fiL41rF5T CULW[NTS <br /> ___-- TILT It4n4N (mlwi" Rr�,.�Ly (�iC7FM[1j <br /> l�lf /ursi yI(�ail !j ri l> I�rn• +�P.S T{,I ras <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal): 2-0 <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION{S)NOLUM>w: �a Ire a I' <br /> COMMENTS: _-- <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO if NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CPRISTY LID,CASING LID AND LOCK)?: YD NO <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: Y' NO <br /> WELL CASING OK?: CYE NO <br /> COMMENDS: — -- <br /> GENERAL <br /> WEATHER CONDITIONS:,, <br /> TEMPERATURE;(specify°C/'F): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? _00V1e- , <br /> COMMENTS: <br /> c.c. Pr031t Manager. <br /> Job Fife: --- <br /> Other. <br />