Laserfiche WebLink
5 <br /> iffig <br /> vt <br /> GIZOUNDWATL'll PURGE AND SAMPLE FORM (care - <br /> L-x>:c�.t _-_.__._.---------------- <br /> PROJI:CT NAME_ <br /> PROJF_1 NUM0EII:___. <br /> SAMPLE DATA: <br /> l t)l=P C1 SAMPLED ---�------�....._�--.—.------�— <br /> SAMPLtNG EOUII'MI-N 1':__-_--' — <br /> COMMI_NiS: <br /> Vowuc - '.MOME Y`T - C0�1AtLH7S <br /> i TV r` <br /> LAuIYI W.OY f,ONYA111c11 p1V[.^,r.nYAllYt 1111.10 7l1FVNaITY cot.ai GWN1K�1 TWY �1uCT11Q{71 <br /> "0. CIXITAMEM TYPE - <br /> F1L1 nA7lUN (r u�11 AT <br /> pvoG) �l( �� �(GnD. m+L@. :It. }��S 7P1I Jns <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL DISCHARGE(gal): � <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)!VOLUME: <br /> COMMENTS: <br /> WELLHEAD CONDITIONS CHECKLIST(Circle YES or NO- it NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID,CASING LID AND LOCK)?: NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?:<:-YNO <br /> W ELL CASING OK?: <>-) NO <br /> COMMENTS- <br /> ------------- <br /> GENERAL <br /> WEATHER CONDITIONS: �IS°F <br /> TEMPERATURE(snecilY'Cf 1=): ! <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? O� <br /> • C't•1C. <br /> COMMENTS: ----- <br /> c.c. Projecl Manager. <br /> Job File: <br /> 01hor: <br />