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I NJ <br /> FIRS <br /> Date: <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont) <br /> PROJECT NAME:_ xx J fy 7--105,Y WELL NUMBER: <br /> PROJECTNUMBER: 1 J`l 51" I PERSONNEL: I'S> lic l <br /> SAMPLE DATA: <br /> TIMESAMPLEO' (6:(r <br /> DEPTH SAMPLED dHj:. <br /> SAMPLING EQUIPMENT: c �r 4 "C; al P•i <br /> COMMEf4I-S:_ If'IrM <br /> {w ,t,� 4rkiSlzkY ry,[r YCi <br /> +iiAS�p(� IK3.A� r.Ot[TNHER P 'V:ry * YOUl1.aExt 'r�'s* 3S adz`_ x :. <br /> hRESCAYTYE T "..-`r eg _ ' PPEn UHOfR, - J.N.lLCAS <br /> aaxrUaars � avPE nL uxa 7vabionr HoFcusroor <br /> 1�taEOUEs'i� F�1a�rt[s�• . <br /> - <br /> - <br /> �{ PURGE WATER DISPOSAL NC)::.5: <br /> .. . <br /> I TOTALDIS�WGE:4gaq_. <br /> DISPOSAL METHOD: <br /> DRUM DESSIGNATION(S)MOLUME: �' r a. C j t � <br /> COMMENTS: <br /> WELL.HEAD CONDITIONS CHECKLIST(Circle YEAS or y0--ii N0,at3�;comrmnts) <br /> WELL SECURrfy DEVICES OK(BOL[ARDS.CHRISTY. ) ASING 1.10 AND LOCK)?: YES <br /> INSIOEOF WEI-LHEAQ. OUTER CASING DRY?: NO . <br /> ;,WELL CASING Or, NO <br /> COMMrrs _ �� we// 6or� <br /> Lail <br /> a .. wi v Csu <br /> VdEATHER CONDITIONS: - .. <br /> �r € TEMPERATURE(spedfyo0rg:PRT,LEMS ENCOUiA7-REE)DURING PURGING OR SAA'IPi:ItdGT.. N <br /> COMMENTS:-_- LfA <br /> r <br /> ' c.E::.P4njaa lrtaragnr=.. <br /> .fob File: <br /> 4-1 <br /> ✓-� .: F. - <br /> < �.�� <br />