Laserfiche WebLink
a M <br /> MA" <br /> 3 <br /> V <br /> GROUNDWATER PURGE AND SAMPLE FORM (Coni.) — — <br /> f ROJf C � xWELL NUMBCII: �— <br /> R �l-?��- K•L. <br /> -- <br /> .— <br /> PROJECTNUMl3ER:—/02-ylrl9 PERSONNEL: <br /> SAMPLE DATA: <br /> TIME SAMPLED*.—)- �;` <br /> DEPTH SAMPLED — <br /> SAMPLING EQUIPMENT: Te ion bouler- <br /> COMMENTS: <br /> - - VOW" .^,1G1'f'EP PRUEA AHALY=' c -< <br /> LAWF'LE. F+O.O{. LOIrTNRCP PRESEftYATIV[ <br /> FIELDf1LLTD- TPRBJ6tY:COLOR C}WN OF CUGTOOY Rt:WE9T C01.IiAE1r1S <br /> RL7 nAllUR AT4-CjYM) S41ET140Ot <br /> C WARACnS TYP - <br /> G <br /> 3 VbA HCS /' LIU Li)�' 4,r.1. }%s Tell Jos&7i�X <br /> PURGE WATER DISPOSAL NOTES: <br /> TOTAL_DISCHARGE(gal)- �' 1 <br /> DISPOSAL METHOD: <br /> DRUM DESIGNATION(S)/VOLUME: v EA L-6-4 <br /> COMMENTS: <br /> r <br /> WELL t IEAD CONDITIONS CHECKLIST(Circle YES or NO--if NO,add comments) <br /> WELL SECURITY DEVICES OK(BOLLARDS,CHRISTY LID,CASING LID AND LOCK)?: NO <br /> INSIDE OF WELLHEAD AND OUTER CASING DRY?: ffiC8�) NO <br /> WELL CASING OK?: ()jES NO <br /> COMMENTS: e• <br /> y-- <br /> GENERAL <br /> WEATHER CONDITIONS: <br /> TEMPERATURE(specify IC/'F): <br /> PR08LEMS ENCOUNTERED DURING PURGING OR SAMPLING? <br /> COMMENTS: <br /> c.c. Project Managor: — <br /> Job f=ile: <br /> Othor: - – <br />