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"t <br /> 6. <br /> GIiOUNDWATEftPURGE AND SAMPLE FORM (cont) °a!e <br /> PROJECT NAME: stlfo's• WELL NUMBER: rZva/ <br /> \ROJECT NUMBER: PERSONNEL-- <br /> SAMPLE DATA: <br /> TIMESAM€`LED• b J <br /> DEPTH SAMPLED(0): tl DH^ <br /> SAMPLING EQUIPMENT: <br /> COMMENTS: `i ' <br /> . - Yw�k �:• d,•;• 3` ka fPRCSrctVA�VC ��� YURff10Ii�' `epi ".51[F`PCO UHDCR v° k��,S�JlAI.Y�f -r LS�,o�k�rb�s"f`-k� e" <br /> - - �'IfO. [01irlUHQiS w �'1' rytt►t� � <br /> ,.' ?k:aY$..� :!nw"1}n�,•ax, s bc.«.i:, �Rix a>liL7Ti.liiOfl Jx „ CVLOli CJ</.IF[OFC115rO0r - <br /> k.„. ,:,..,:.�.^. •:.(�.rq i 3wr, y, ”` aay" s ,�, itLQUEST k d .v+--':§"tOuuEeti'S - <br /> URGE WATER DISPOSAL NOTES: <br /> NOTAL DISCI-I�1f30E(gig: i <br /> ! ` rDISPOSAL METHOD: <br /> 'DRUM DESIGNATION(S)NOLUME <br /> COMMENTS: TIL;( i x <br /> r _ i <br /> WELL HEAD CONDITIONS CHECKLIST(Cirda YES or NO--d NO.add oonunants) <br /> ' WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID CASING LID AND f_OCI(�?: � NO <br /> INSIDE OF WELL HEAP AND OUTER CASING DRY?: DE NO <br /> WEU CASING OK?: NO - - - -- <br /> 3 COMMENTS::: <br /> I <br /> , f <br /> GENERAL <br /> - <br /> WEATHER CONOfTIONS vV w�T✓ t�`y� . <br /> TE�cPERATURE(sy '_' 3 `'. <br /> f'R08LEMS ENCOUNTERED DURING PURGING OR SAMPLING? 1Jt�f <br /> COMMENTS: • <br /> .P"gou.Wrmger: <br /> .lob Fate: . . <br /> i <br />