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.n <br /> ?a <br /> GROUNDWA._=R PURGE AND SAMPLE FORM on <br /> f <br /> PROJECT NAME: �x on _T )1J S0 WELL NUMBER:_ <br /> _ _ , <br /> PROJECT NUMBER: <br /> . ` p . I PERSONNEL: <br /> SAMPLE DATA: )3� )0� TIME SAMPLED: (,S <br /> DEPTH SAMPLED(ft): <br /> SAMPLING EQUIPMENT: <br /> COMMENTS: <br /> r F� <br /> t s _ VOIVFIC [ 'f 54N4'f DUNDCn A}iALY9S .f 43C041lAEFTFS� <br /> Rd OF•r CtlFlTAlRER 'FlE� -FlU.T9 TVTIDIDJJV COLOR CIeNN OF CVSTOCY RCOVFST Z `� 3 <br /> ;SAeiViE` HFltS TYPO S i'RGERVtAT1YE FTETRATtOf4 L�a� 'AT i�:lYrt+l "l4tETHODI .- . <br /> No_' ccwTu sr5. <br /> [nnw7 3 Val. :4-G2 <br /> PURGE WATER DISPOSAL.NOTES: <br /> TOTAL DISCHARGE(gal): � <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)NOLUME: <br /> COMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--it NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID, <br /> CAS:ti` L!D AND LOCK)?: ' NO <br /> EL <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: Y'W NO j <br /> WELL CASING OK?: &r!�, NO <br /> COMMENTS:` <br /> GENERAL /eQ� <br /> -- WEATHER CONDITIONS. <br /> TEMPERATURE(specify°CrF): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS: <br /> c.c. Project Manager: <br /> Job File: <br /> Q1heC <br /> i?a <br />