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GROUNDWATER PURGE AND SAMPLE FORM (Cant+} Date: <br /> PROJECT NAME: VZCVIN WELL NUMBER: <br /> PROJECT NUMBER:b7 l tf_ PERSONNEL: , Q f - <br /> SAMPLE DATA: <br /> TIME SAMPLED' 2� <br /> DEPTH SAMPLED(ft):- <br /> SAMPLING <br /> ft):SAMPLING EQUIPMENT: _T CJ &&tUE.2 <br /> COMMENTS: G — . <br /> aa,:kYaa,c <br /> . SA►Wl$• ?a•'.«,rat # OaH-rtat " p:A7Q.,'-.�:i:'�awm.h,.rE:H^sxuo�aana:�vOfu6t � n*."-" �COLbi.t.�s'�aS'l ii��llHfTPQ�EFcoaI1Y1t1stP0YqEo�RoY,� <br /> �AFCAtYSe3 -xz"X` .�e <br /> �..'.'�. <br /> wZV ° rS r k <br /> nag odAUR ! <br /> fx - <br /> Muj 3 % a <br /> PURGE WATER DISPOSAL NOTES: ... <br /> TOTAL DISCHARGE(ga1): <br /> DISPOSAL METHOD: Ct <br /> DRUM DE:SIGNATION(S)N UME: ' <br /> s' COMMENTS: <br /> a <br /> 3 <br /> WELLHEAD COND1riONS CHECKLIST(Ctrde YES or NO--i!NO,add oommnts) <br /> i` WELL SECURRY DEVICES OK(13011-ARDS,CHRIS7Y UQ ASING UD ANQ LOGIC)?: YES NO <br /> INSIDE OF WELL NF.AU D OUTER CASING DRY?: ES O <br /> WELL CASING OK?: ES O <br /> COMMENTS: - <br /> [r <br /> GENERAL <br /> WEATHER CONDITIONS: <br /> TEMPERATURE(specify°Crr-): *0 <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SA WLING? <br /> { COMMENTS: <br /> i <br /> c c. Pmjed Manage <br /> Job File: <br /> Other. <br />