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k <br /> rw <br /> GftOUNDWATIER PURGE AND SAMPLE FORM (cant.) <br /> PROJFCrNnMt : L x x�'^� T : / WELL NUMBER: <br /> PROJECT HUNKER:--- PERSONNEL: `�— <br /> SAMPLE DATA: <br /> TIME SAMPLED:----/—/'1/C-' _ <br /> DE=PTH SAMPLED <br /> SAMPLING EOUIPMENT: <br /> COMME=NTS: <br /> YOLIIYC .. - 51:M'Fa 1Fh0E11 At14LY51S CQYNCHIS.: <br /> O'G1STO0YnFLDH TURIU.buY C(A.ON CfWHOr CONTA1NEf (f1E5CRVATIVE LTI (YM1 {fuiC[OTlIliCO-7OT) <br /> OTAMEY�C 1AOMAt 4-C <br /> .. <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE_(gal): <br /> DISPOSAL METHOC: <br /> DRUM DESIGNATION(S)NOLUME:• <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 WELL HEAD AND OUTER CASING DRY?: YES NO <br /> WELL CASING OK?:- ES-, NO <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS: UGCGt� <br /> TEMPERATURE(specify'CI'F): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS: <br /> c.c. Project Manager. <br /> Job File: <br /> Other:_ <br />