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a -r <br /> a <br /> { <br /> Dain: <br /> ---- GROUNDWATER PURGE AND SAMPLE FORM (Cont.) <br /> PROJECT NAME: WELL NUMBER:_ <br /> PROJECT NUMBER:_ i G d LI C_. I `I PERSONNEL: <br /> SAMPLE DATA: �— <br /> TIME SAMPLED: <br /> .)EPTI-I SAMPLED <br /> SAMPLING EQUIPMENT:- <br /> COMMENTS'. <br /> :_COMMENTS: <br /> ANALY Sts �^ <br /> YOLHYL - .. S4fF�ED UNDER _ COIAMENYS <br /> . r1EC0 - F1Ea1L9T <br /> SAIAPU -NO.DE C�iYPEER PREARVAT1VE nL7nATFON m1 uE17 TUHDIDITY COLOn CIIAAT4-CUSTODY (urTMD) <br /> I AT i"C(YMI <br /> 'NO. WNPUNEn9 <br /> MWIt} <br /> 3 VuA I-I G I I yU. I H,51^ Gr \ �'5 <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal): �?• `� a I. <br /> DISPOSAL METHOD.- <br /> DRUM DESIGNATION(S)NOLUME: f l- ` ' <br /> COMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--it NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID,CASING LID AND LOCK)?: YES D NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?: AYE%NO <br /> WELL CASING OK?: S] NO <br /> COMMENTS: —� <br /> GENERAL <br /> WE ATIjEA CONDITIONS: <br /> TEMPERATURE <br /> PROBLEMS ENCOUN7 EIIED DWAING PURGING OR SAMPLING?_ <br /> COMMENTS: LAA11 i,---� f <br /> s <br /> c.c. Project Manager: �----- -.----'� �_ <br /> Job File:— <br /> pular:— <br />