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GROUNDWATI-R pURGE AND SAMPLE FORM(C°n1-)___.Y -_-- <br /> �x�.lNl3M[3Efi:._.- <br /> PI�O.IE:CT <br /> PR0.11=CT NUM12, 1:�- <br /> I-,:RSONNLL: <br /> SAMPLE DATA- I 3 --- <br /> TIME SAMPLED:------ <br /> C)r.pT i SAMPLE=D(It):_ <br /> SAMPLING C-oUIPML-NT: j ler <br /> COMMENTS: -----�" -- <br /> MULpt15 Lp6UAf HIR <br /> YIX.0 LTE ... .-. gLQ"OF CJ1filOUY <br /> I1CW narn Tull, DITY 60(.OH (uE.11"ui <br /> (,()f11A1HYA AT�'�tYAq <br /> G:MAi'LE PHGCITVATIY>: i1LTHATI0r1 ��-�_ <br /> Na CoNTNrura~ TYPc,,:_ ___ 1('!�Jns f77FaY <br /> rylwl� 3 - <br /> PURGE WATER DISPOSAL NOTES: -7 <br /> l'OTAL DISCHARGE(gal); .( Trrri <br /> DISPOSAL METHOD: r <br /> r A rr7 <br /> DRUM DESIGNATION(S)/VOLUME: <br /> vT 61'T i� <br /> COMMENTS: <br /> li NO,add comments) <br /> BOLLARDS.Cl�R1SNY LID,CASING LID AND LOCK)?: NO <br /> WELLHEAD CONDITIONS CHECKLIST(Circle YES or NO <br /> WELL Sp DEVICES OK( (g� NO <br /> INSIDE OF WELL HEAD AND OVER CASING DRY?: <br /> WELL CASING OK?: <19� NO <br /> COMMENTS: <br /> GENERAL <br /> cd-1 <br /> WEATHER CONDITIONS: r, <br /> TEMPERATURE(specilY°C/'F): <br /> ENG OR SAMPLING. <br /> PROBLEMS ENCOUNTERED DURIN�� <br /> COMMENTS: <br /> c.c. Project Man39or_ — <br /> .lot]File: <br /> OlhoC <br />