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d <br /> Date: - I 1 j <br /> GROUNDWATER PURGE AND SAMPLE FORM (core) <br /> PROJECTNAME: C QTS - Ed j� WELL NUMBER: rA <br /> PROJECT NUMBER: k PERSONNEL: . K R <br /> SAMPLE DATA: <br /> TIME SAMPLED- 24 <br /> DEPTH SAMPLED(ft): <br /> SAMPLING EQUIPMENT. b k,- Lt, 1 <br /> COMMENTS: <br /> sCRVA <br /> aaf. ou <br /> �YPE In . W - vNLcrt4vr(da{s f TY -Y'�b� Y 'Y f <br /> �- Y±n *�'rYi}� fil•1RAw. ; �►W tOoY t,1[OUEtSY _ <br /> rtxve r rr�c .naffs Af,�.�.,s.S. c: :z�aa�aa - l�,w h.-�rto„r�'.o`�"�e# '- ba�..'�sS��li s;Ch'R9� .. .. . . i ,p, •,.yt"�'C' 1iT5 E <br /> 1 1laFl 1A(', Lai t� ra�� t 4 E (� <br /> .nP✓ f <br /> r� - <br /> t <br /> PURGE WATER DISPOSAL NOTES: <br /> ' TOTAL DISCHARGE(gaq:. <br /> DISPOSAL METHOD: 9-0 Y rG <br /> DRUM DESIGNATION(S)MOLUME: R bP r Cti <br /> COMMENTS: <br /> WELL HEAD.CONDITIONS CHECKLIST(Circle YES or --it NO.add oommer�ts) <br /> WELL SECt)R(TY DEVICES OK(BOLLARDS,CHR <br /> IS7Y Lt CASING LID AND LOCK)?: YES [ <br /> _.. <br /> INSIDE OF WELL HEAD -OU7 ER CASING DRY? YES NO <br /> WE L CASING OIC?:. S NO - <br /> COMMENTS <br /> n� Clew <br /> GENEAAi. <br /> WEATNFA CONDmONs uM <br /> TEMPERATURE <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS: 2 <br /> cim Pmiga #tanager <br /> . Job Fie: —�_ <br />