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r: y <br /> �- Dila: 3-Ly <br /> GROUND ER ER PURGE AND SAMPLE EORM�,.6..) <br /> ~w PROJECT NAME: <br /> WELL NUMBER: <br /> PROJECT NUMBER: <br /> jOZS�•'I� PERSONNEL: Mw / <br /> Y ,.. <br /> SAMPLE DATA: <br /> TIME SAMPLED' tiS Aeek6 <br /> DEPTH SAMPLED(11). <br /> SAMPLING EQUIPMENT: <br /> (6n baa Ier -- <br /> COMMENTS: <br /> YoLuuEjSICPPCOUROER 'ANALY575 t y 2.�IilAEHTS f {- - <br /> ` SAUPL£ --Na OF. CONTAfNER r _FiEIA RLLFD TURluNTY COLOR GIAIR OF GUSYODY j,Rr-0UESi .�J:ux .y ` <br /> ., 'iyP£t' PRES£RVAYIYE FILTFU1T10H ..cv -AT�-C lYM7 ;:{1AE17 <br /> . <br /> G011YA1R CRS :`stir . ..:.:........... ... ..s. ., <br /> PURGE WATER DISPOSAL NOTES: 3� a1S <br /> TOTAL DISCHARGE(gal): <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)IVOLUME' <br /> COMMENTS: - - <br /> WZ L HEAD CONDITIONS CHECKLISiT.(Circle YES or NO--if NO,add comments) <br /> WELLSECURITY DEV'-CES OK(BOLLAFDS,CHRISTY LID.CAS:?:',L!D AND LOCI()?: NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?: NO <br /> WEL-LCASINGOK?: )X-:6 NO <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS: <br /> TEMPERATURE(specify'CPF): >]'� <br /> --- PROBLEMS ENCOUNTERED DURING PURGING OR SAMPl.1NG? <br /> COMMENTS: <br /> C.C. Project Manager: <br /> Job File: <br /> Qther.�l— <br />