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G <br /> M <br /> V <br /> IN <br /> _---- GROUNDWATER PURGE AND SAMPLE FORM (pont.) _ <br /> J <br /> F•x-ar %3V-2 WELL NUMB2R:-_..----� <br /> PROJEGT NAME-:----- --- r �('•!-. <br /> lozyG,.l9 <br /> M•ti• <br /> PROJECT NUMBER:_ PER5dNNEt: <br /> SAMPLE DATA: <br /> TIME SAMPLED_ ��1---- - - - <br /> DVPTH SAMPLED <br /> SAMPLING EQUIPMENT: <br /> L��� — ----' <br /> COMMENTS: <br /> �.�--• "� .fi111F'PLO u110ii1 ..ANAL�+IS [;pltli[1fTTi . <br /> YoLuuC .i IIEWWT <br /> CUFITASHEi1 - RLW 11LLT: TIJRDIIX'Y fALWI GWNO-C(y 706 'UT021' <br /> 021 <br /> Ho.OF PReSrRVATIYC IILTMT10i1 mlwll „ -;AT a-Crfrrhs <br /> rlo eoluul frls <br /> TYPE. <br /> _ I 7P11 as <br /> L � <br /> PURGE WATER D"SPOSAL NOTES: <br /> TOTAL DISCHARGE(gal)L <br /> r oel tim <br /> DISPOSAL METHOD: EA ------ <br /> 1--�— <br /> DRUM DESIGNATION(S)NOLUME: ^ <br /> CUMMENTS: <br /> WELL HEAD CONDITIONS CHECKLIST(Circle YES or NO il COASING LID AND LOC.add comments) K)?: CL�E9 NO <br /> WELL SECURITY DEVICES OK(BOLLARDS, HRIS LID, <br /> INSIDE OF WELL HEAD AND OUTER CASING DRY?: ,S NO <br /> WELLCASING OK?: CE J?NNOYIEi <br /> COMMENTS: <br /> GENERAL •IPS �~ <br /> WEATHER CONDITIONS:--( ��OF <br /> TEMPERATURE(SPecily°C!°F-): <br /> PROBLEMS ENCOUNTERED DURINGI RGIN <br /> G OR SAMPLING? c�rT <br /> COMMENTS: f_ <br /> w <br /> e.c. Projed Man- ------ <br /> Job File: <br />