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it <br /> Dale: 1A i <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont.) <br /> PROJECTNAME: Ogmlw<�P- t.;v• £14; .J' WELLNUMBER: Mw { <br /> PROJECT NUMBER: r PERSONNEL: <br /> SAMPLE DATA: <br /> TIME SAMPLED• <br /> DEPTH SAMPLED((t}: <br /> SAMPLING EQUIPMENT: Iris:, <br /> COMMENTS:_ S,rnrf- 6LLj F c%Sf 0 &P A)6 <br /> yjj LE,' aNao 11£Rr Zlngym• AELDe�.YOCUI ; P,fE0 UN0FR ^ r i'1JtALYRS x"' <br /> :4i'tf0.�"` LOfrTNFtERS ' PE ?+y..`��� �� � atf�A1�`'` ilsY04Y itfiQiJEsi `'" "E� <br /> W. ` BE <br /> Lv 3 von- . I Mo 0 eT-YF_froµ- <br /> PURGE WATER DISPOSAL NOTES: . <br /> f 1 TOTAL DISCHARGE(qal�: f? <br /> DISPOSAL ME HOD: .. <br /> DRUM DESIGNATION(S)/VOLUME: EPr 4 L <br /> 4 - <br /> I COMMENTS' <br /> € WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO—d NO,acid oortumnts) � <br /> WELL SECURI7Y DEVICES OK(BOLLARDS,CHRISTYNG LID AND LOCK)?: O <br /> INSIDE OF WELL H OUTER CASING DRY?: ES NO <br /> WELL CASING O{ NO <br /> COMMENTS: <br /> 4 GENERAL <br /> WEATHER CONDITIONS: FIA (R 7 <br /> TEMPERATURE( <br /> speafy �: <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? i 0 7 'pQ0G(-&M <br /> COMMENTS: <br /> -- fV4N < <br /> F <br /> cc. Projed Manager. <br /> Job File; <br /> j Other. <br />