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MatONi <br /> xc x r x1 y Y M- 0 <br /> r <br /> Datu: _— <br /> I " <br /> GROUNI)WATI:,n PURGE AND SAMPLE FOfiM (Cont.) - <br /> j`)� -WELL NllMI3ER:_---.-1�!�------.—.---- <br /> PROJECT VAMC: <br /> PROJECT NUMBER' /c'r �_ � PERSONNEL: <br /> SAMPLE DATA: �o v- <br /> TIME SAMPLED: -- <br /> DEPTH SAMPLED(fl):r---L �—. � �✓ ��„4-� i ,1�� <br /> SAMPLING EQUIPMENT: <br /> COMMENTS:--� -- — <br /> -- - slowEDURUER ARALYSIS � H£HTS . <br /> - VOLUME CfUJH OF CUSTODY ';RL'ODEST- <br /> COFITAINEF{ .F, ❑ FTLLTP TUMUIDITY COl.OA AF�'C lYM7 (11ET}12DI. <br /> SAMPLE HO.00R^ ..TYPE i'nEST RVATIVE nLTH ROH (ml or Yl ^-� P—7f��� c; <br /> NCL <br /> � N-lam` Ile9l -- T G f� <br /> ir <br /> Ir f �I <br /> PURGE WATER DISPOSAL NOTES: �� <br /> TOTAL DISCHARGE(gal): <br /> DISPOSAL METHOD: <br /> IVOLUM>w:---,6, 1 r; �.G` <br /> DRUM DESIGNATION(5} –1-- <br /> COMMENTS: <br /> WELL HEAD CONDITIONS Ct',ECKLIST(Circle YES or NO--if NO, add comments) <br /> W <br /> EL.L SECURITY DEVICES OK(BOLU\RDS,CHRISTY LID,CASING LID AND LOCK)?: S NO <br /> INSIDE OF WELLHEAD DAAN�D OUTER CASING DRY?: E <br /> NO <br /> WELL CASING OK?: fES3 NO <br /> COMMENTS: <br /> GENERAL- <br /> WEATHER CONDITIONS: - ' J <br /> TEMPERATURE(speciiy'CI°F): 1 <br /> pROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING?-=---------- <br /> COMMENTS: <br /> ti <br /> C.C. Proji� Managar. <br /> Job File: <br />