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i <br /> -- GROUNDWA7Eri PURGE AND SAMPLE FORM (cont.) <br /> PROJECT tJAME:--&Y-X <br /> PROJECT NUrhBER:- ' `—'' _ <br /> %�/' PERSONNEL: —� <br /> SAMPLE DATA: l <br /> TIME SAMPLED' <br /> DEPTH SAMPLED{tf): ' - a <br /> SAMPLING EOUIPMENT: <br /> COMMENTS: <br /> -- -' :SloPPEa UYYOCn -;ANALY`+` - <br /> :-. NEWY.ST .COu1.tCHTS <br /> CONYAJNENk- ,Ft CD TU NCIIIXTY COLOYi CkWNOF CUSTOnY (YCTilO01 .. <br /> SAZxPLL YYO.OF.: TYPE' PrtT✓EHYhY1YF. riLTRATTOH � AT 4_ 'O^ YYM1 <br /> GHQ CONTAINEfK .. <br /> _ <br /> 3 Ila t/n !Gtti� vet �j :x4 <br /> PZ <br /> Uo.� <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gat): <br /> DISPOSAL METHOD: - <br /> DRUM DESIGNATION(S)/VOLUME. <br /> COMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circ!e YES or NO if NOr add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CDR`!TM LID <br /> NO <br /> LID AND LOCK)?: ES NO <br /> INSIDE OF WELLHEAD D OUTER CASING + <br /> WELL CASING OK?: iTSJ NO <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS: <br /> TEMPERATURE(specify*GrF): <br /> PROBLEMS ENCOUNTERED DURING PURGING Oil SAMPLING. <br /> COMMENTS: <br /> -� <br /> ------------ <br /> c.c. Project Managor. <br /> .lob File'— <br />