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811 <br /> -r <br /> Oato: ,�IS•9i <br /> GROUNDWATER PURGE AND SAMPLE FORM (cant.) --- -- <br /> bora 7-�5� � WEI I-NUMBER: <br /> PRC7JLCT NAME:- --- — <br /> PROJECT NUMBER:— jpzu,-) -- PERSONNEL: <br /> SAMPLE DATA: � <br /> TIME SAN.PLEiJ:_��', (s� <br /> t7EPTl l SAMPLED(h): <br /> Te ion �o�i)ef <br /> SAMPLING EQUIPMENT:--- — <br /> COMMENTS:_ — <br /> rZt`ylC <br /> �~ 'w441t6 UHOElt AHAI.r.',iS s <br /> nF10:.', YOLLLuC PEOUEBT dN.t1,tL FB <br /> 6F L61i TA1NER PRESERv '' rIk1ED T66IMf%TY /IX.OR !'AUUHD CI:STe6Y `(uLT116e1 . <br /> Ha;: coIITAiI+r.Rs <br /> tYPE ' nlTRA116H FILLED <br /> AI`4 t:'." <br /> Rau 3 V0 Hcy / -yes- <br /> PURGE WAT ER DISPOSAL MOTES: <br /> TOTAL DISCHARGE(gal)L. —.Jl -- <br /> DISPOSAL METHOD: �--- <br /> DSUM DES:GNAT'ION(S)NOLUME: ICA <br /> COMMENTS: <br /> WELL P AD CONDITIONS CHECKLIST(Circle YES or NO--if NO,add comments' YE NO <br /> WELL SECURITY DEVICES OK(BOLLARDS,Ci MISTY LIDr%ASING LID AND LOCK)?: C� <br /> INSIDE OF WELLHEAD 6NO-OUTER CASING DRY): (::Y�E' NO <br /> WELL CASING OK?:�NO <br /> c;OMMENTS: I <br /> GENERAL <br /> WEATHER CONDITIONS: <br /> TEMPERATURE(SPecily°Cl°i}: <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS:4/7 <br /> c.c. project Manager. <br /> Jnt1 fila: <br />