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s <br /> a <br /> �----- GROUNOWAThti PURGE AND SAMPLE FORM (cont.) <br /> PROJECTNnME :_�*x,-,, l 1 f'?----WE=LLIUMLIER:__ i <br /> PROJECT NUMBER: (c'/ Ll PE=RSONNEL: — <br /> SAMPLE DATA: _ <br /> TIME SAMPLED:- <br /> DEPTH <br /> AMPLED:DEPTH SAMPLFD(H): 4 C ((c t �_— <br /> SAMPLING EQUIPMENT:_ ` — <br /> COMMENTS: --- <br /> SAIAI'LE RO.Or CONYPE i1CLD. <br /> YOLUFIE - Si YfY'CO UIIOf.II - A7ULY� <br /> F'll"CRVAML 1 ED TUIIDIDITY COLOR CkUdf-0OrO 110111 ItEWk.ST ComuCRTr <br /> .µp, OONTA18015 .TYPE - RLT ISATiOR . rll AT 4-C(YJM - (m1,TWD) . <br /> PURGE WATER DISPOSAL.NOTES: r <br /> TOTAL DISCHARGE(gel): � C CA-yl <br /> DISPOSAL METHOD: r�rL ll' .qZ <br /> DRUM DESIGN ATI ON(S)/VOLUME: rl tr 4x . <br /> COMMENTS:r <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YE=S or NO--if NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID,CASING LID AND LOCK)?: ES J NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?: C ES NO <br /> WELL CASING OK?: ES. NO <br /> COMMENTS: `-'- <br /> GENERAL <br /> WEATHER CONDITIONS: 2 G y <br /> TEMPERATURE(specify,GrF): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? r <br /> COMMENTS: <br /> 0 <br /> c.c. Project Manager. <br /> Job File: <br /> Other: <br />