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5. <br /> GE30Uf9DWl1T>rR PURGE AND SAMPLE- FORM (cOnt- --- ---- <br /> xo�1 Wt:l_t-NUMt3ER:�._ <br /> PROJECT NAME:__-.------- ---- — - - <br /> -R- /M.f�K•L. <br /> PROJECT NUMBER: �p�.x`��=fig _ m:P1RSONNEL: - — <br /> SAMPLE DATA- <br /> TIME SAMPLED- <br /> DEPTH SAMPLED(it): ---.--- <br /> SAMPLING EQUIPMENT:— -- <br /> COMMENTS: --.-''� <br /> 51�>'YFA uHUCR A11ALYW <br /> Vo�uL([ letaiEsr ea"WS <br /> SA1�f'l.G.. NO - 'CONYAINCn pFiFSERVAYVV[nLS RA�oH �nt1CD 7711107IXTY co�ori c1 A� 4YnC Y '.(UC11i0o)::,. <br /> H0.; p GONYAII{CiiS Nom. - (mt°rq . <br /> nZ- 3 <br /> VaA HCL ' L10J i,'«!lt l,W Yes TnE1Y2s <br /> 13r c <br /> PURGE WATER DISPOSAL NOTES: l / <br /> TOTAL DISCHARGE(gal): <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S}NOLUME: &a ! eI <br /> COMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO--if NO[add comments} <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID,CASING LID AND LOCK)?: LF,D NO <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?: �V NO <br /> WELL CASING OK?: <I ' NO — <br /> COMMENTS: <br /> GENERAL <br /> WEATHER CONDITIONS: Lsf <br /> TEMPERATURE(Specify°C! <br /> PROBLEMS ENCOUNTERt=4 DURING PURGING OR SAMPLING? '1'�� � <br /> COMMENTS: <br /> c.c. Project Manager. <br /> Job File:_� —•— —' —� <br /> Olhar: �---- <br /> r <br />