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a _ <br /> d', di wt z -'ba• k.k <br /> la"4 <br /> GROUNDWATLti PURGE AND SAMPLE FORM (C0110P1j0.1i:CT NAME:_-- <br /> C KrTr1 ____WELL NUMBER:--.— <br /> - <br /> !C L 1r�'• !�[_ PERSONNEL:— <br /> PROJECT NUMBEii:____----'- <br /> SAMPLE DATA: <br /> TIME SAMPLED: - <br /> DEPTH SAMPLED(fl):.---- <br /> r- <br /> SAMPLING EQUIPMEI�ET:-- -- -- <br /> COMMENTS: <br /> 5{1PPCS UNUCR 'ANALYSIS'.. C,OMM.E <br /> VOLIJUEuEOUEST <br /> riELU FlLLro, TUft1U01TY COLON 04U"OYCUSTOOY (uETI100) <br /> SAMPLE NO.of CONTAIKR pTIrSERYATIYE FILTRATION . AT4-C(YA9 <br /> No. COJITAINEFY .TYPE (nil ar 11 <br /> PURGE WATER DISPOSAL.NOTES: ] � ` c /,Liter 5' <br /> TOTAL DISCHARGE(gal)- i5L L <br /> DISPOSAL METHOD: 1;—s' r vi <br /> DRUM DESIGN ArjON(S)NOLUME:� Ea E" " <br /> COMMENTS:"- <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--if NO,add comments) NO <br /> ,� <br /> •VICES OK(BOLLARDS,CHRISTY LID.CASING LID AND LOCK)?: ceD <br /> WELL SECURITY DE <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: �J NO <br /> WELL CASING OV: -(fs) NO <br /> COMMENTS:f- <br /> GENERAL <br /> WEATHER CONOITIONS:� �� Y <br /> TEMPERATURE(specify`CrF): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? `-�— <br /> COMMENTS: <br /> C.C. Project lvManagor. <br /> Job File: <br /> Other; <br />