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I Da:o: <br /> ----- GFIOUNDWATL II PURGE AND SAMPLE FORM (coni.) <br /> - r z. f 1 - <br /> PROJECT NAMf:__�-?c.xf?!✓ �f----WELL NUMf3ER:��:--.- <br /> PROJECT N!'nhf3EFi:_I1?���� .. I�� PERSONNE=L: <br /> SAMPLE DATA: <br /> TIME SAMPLti.._– <br /> DEPTH SAMPLED(It): <br /> SAMPLING EQUIPMENT: <br /> COMMENTS: –� – <br /> SA4[,^lS NO,O( CONTAINER- FTE[Il <br /> YOLUur. - �— G1914'EU UNULF1 ANALYrAS <br /> COAUAENTS <br /> PIiE5ERYA1lVE {tLTRTION iTl]-EO TUN[7lOt1Y Mon CHAIN Or CU..TOUY - 11r.O(jC 0 <br /> CONTA <br /> INENA <br /> �., TYi'E' (ml or 11 A 4•C IY!!q <br /> 11 �_7 <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)IVOLUME: r~f� <br /> COMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO- if NO,add coniments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY,L! CASING LID AND LOCK)?: YE5 NO <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: YES ' NO <br /> WELL CASING OK?: YES NO <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS: <br /> TE MPERATURE(specify°CI'F): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? — <br /> COMMENTS: <br /> k <br /> c.c. Project Manager: <br /> .fob File: <br /> D?her: --------- <br /> MIN Pfflaw", <br />