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G11JROUNDWATER PURGE AND SAMPLE FORM (conL) Date: <br /> PROJECTNAME:J(ui'_I.n'1er C SC sc�C tl WELL NUMBER: iu <br /> �ROJECT NUMBER: j J 2 sly, f!� PERSONNEL: <br /> SAMPLE DATA: <br /> TIMESAMPLED• <br /> DEPTH SAMPLED <br /> SAMPLING EQUIPMENT.-- <br /> COMMENTS: <br /> QUIPMENT:COMMENTS: N1 dnl <br /> s <br /> Ig �ZOt{iA!!4H x 7x.>,:. t--ayn�'i YOLUt1C c`.'"s� .. :SF�IY`tO VkOCA v" 'y -jut4L1'nS., .� {`}f - gym% <br /> K <br /> •x. Y.c � PrtlCSCRV�AIiKE ri 17lLtb t1f(701bftY COLOR GWNOF 41lST001' lei+iCClEST{z ti. yw:47xt: - <br /> .. Gq{ip{kCRS yx7YPE-FR: a-•.¢ ,�`. gx4 ltllitA7101! .r'i.er [ - y` f• y u r 'v�:5' this ,+ SiMCKfS �;. - . <br /> PURGE WATER DISPOSAL NOTES. <br /> TOTAL DISCHARGE(gal): <br /> . DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)/VOLUME Llc�i t <br /> COMMENTS: <br /> WELL HEAD CONDITIONS Cl fECKUSI'(Circle YES or NO—d NO,add com mems) <br /> WELL SECURITY DEVICES OK(BOLLARDS,C44RISTY LID,CASING LID AND LOCKq?: ES NO <br /> ` INSIDE OF WELL HEAD AND OUTER CASING DRY?: NO <br /> iNE3 LCAStNG OK?: NO <br /> '.. COMMENTS: - -- - - -- <br /> GENERAL <br /> WEATHER CONDITIONS 1�/Sa�i1• <br /> TEMPERATURE(specify-CrF): 'f� <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS: <br /> 'r r ti <br /> s <br /> a C-r- Pmjed Wnager. <br /> 3 fob Fjo: - <br />