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q- - <br /> ad <br /> 5 <br /> GROUNDWATER PURGE AND SAMPLE FORM (cont.) -- <br /> Txx1�.a ___--____WE:I-1_NUM13f�R:�� <br /> PROJECT NAME: _=.- --_— — <br /> PROJECF NUMi3(-R:_ loz,rG.19 PERSONNEL: <br /> SAMPLE DATA: �_�----- ----TIME SAMPLEC �_--_— <br /> DEPTH SAMPLER <br /> Tekon F�aike��.�_� <br /> SAMPLING EQUIPMENT: J_•._�,_.. <br /> COMMENTS: <br /> sw ilcD uru7C!(; AMLY+IS <br /> YOLUIIC <br /> ' " . l)f ct1 T (HuCCoT"E10"l <br /> nCW I-LLm THOY CO01lciwIA <br /> . 'c <br /> "uPLF . cONTlHin1Ar6} LWItKHTU <br /> _ <br /> N0, c011TF(MIWS TYPE (mt^IIIq p _ <br /> �r1K rT1F(l br i Yes rnor5_— u <br /> 7 3� voA F-3 c !1`i <br /> PURGE WATER Dlf' 'OSAL NOTES: <br /> TOTAL DESC}•IARGE(gat): <br /> DISPOSAL METHOD:_ <br /> DRUM DESIGNATION(SjlVOLUME: <br /> COMMENTS: n <br /> WF LL HEAL?CONDITIONS CHECKLIST(Circle YES or NO- if NO,add comments) <br /> WELL SECURITY DEVICES OK(SOLLARD , DRY?Y LI=D,CC�A NO LID ANq.LOCK)?: �E NO <br /> INSIDE OF WELL HEAD AND OUTER <br /> OUTER CAS Lys <br /> WELLCASWGOK?: tgp NO <br /> COMMENTS: -----— <br /> GENERAL <br /> WEATHER CONDI.iONS:�L r `f��� <br /> TEMPERATURE(spee1fy'C/'F): <br /> PROBLEMS ENCOUNTERED DURING PURGING OR SAMPLING? o^�= <br /> COMMENTS: cl�� <br /> c,c. Pr6iect Manager. <br /> Job File: <br /> Otho:- <br />