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Dales: IJ'1S•'7� • <br /> ----- GROUNDWATER PURGE AND SAMPLE FORM (cont-) - <br /> f_=x1:ni1 ✓' .Sl�'7 WI=LI.NUMBER: —.-..�---- <br /> PI1OJI=Cr <br /> PROJr--CT NUMI3CIi: lUfl/f.!9 <br /> SAMPLE DATA: <br /> TIME SAMPLED' <br /> DEPTH SAMPLEp{ft): lon ba�l�r <br /> SAMPLING EOUIPMENT: — <br /> COMMENTS: <br /> ':5711F'PEO UfrDf3i AHOUE19T <br /> YDLUUC .. fi[WEJ`T .i <br /> ---1'1OF"": GONTNFSf1 r1C111, F7U.Ilf 7UfiNOF1Y COlOr1 dU.tN OF Ci1S7OGY <br /> SA11Pr-E.. rf1L.C11YA17Y[ f11.7M110H AT�r(Yrtq -'{71[711061 ' <br /> tio. MUM'S <br /> - ttOmQ Wru !rc 1. YP.S TPIIJas 8y2tX <br /> 3 VOA N CLQ / ---- <br /> PURGE WATER DISPOSAL NOTES: �n cn�ll <br /> TOTAL DISCHARGE(gal): �v <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)NOLUME- J EA �ej - <br /> COMMENTS: <br /> WELL HEAD CONDITIONS QIECKLIST(Circle YES or NO--it NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID,CASING LID AND LOCK)?: NO <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: (fE�) NO <br /> WELL CASING OK?: kj�.� NO <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS: 4 r <br /> TEMPERATURE(specilY'GI°F): s r <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING-2 <br /> COMMENTS: �rtv <br /> c.c. Project Manager: <br /> .lob File: <br /> 01har: <br /> 1 <br />