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w r- IN:�RM.A ... <br /> NFO TION SHEET <br /> Sampling Date: <br /> Sttem <br /> Project No. <br /> III e t natio : <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water is the well box ES Above TOC Below TOC <br /> Is top of casing cut lever NO if no,see remarks <br /> Is°vett cap sealed and locked? NO If no,sed remarks <br /> Height of well casing riser tin inches): <br /> Well cover et "or 12" 2"�� "or 12" "Christy <br /> 12"Christy 1, 1 12"3V D 12"DVR <br /> 12" "CNI 2" ' ecz- Other: <br /> General condition of wellhead assembly: Excellent Goad Fair Poor <br /> Purging Equipment: "disposable bailer Submersible pump <br /> "PVC bailer Dedicated ted bailer <br /> "PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer i po xableTubing_ <br /> ll i star: 2" " 11 �� <br /> PurgeVol, Multiplier: 1 a t 1 , <br /> Initial-Measurement —Rec e Measurement <br /> TiTime: Calculated purge: <br /> Depthof well: Depth to water: Actual purge-15L—IL— <br /> Depth to water: <br /> Start purge: Sampling time: <br /> Time erature E.C. H Turbidityolu e <br /> a <br /> 117 <br /> Sample appearance: ce : <br /> Equipment replac ed: (check all that apply) Note condition `r laced tear(s) <br /> 2"Locking Cap: Lock: 7/32 elle e d: <br /> "'Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> " el rt Cap: Pinned.elle ead _ <br /> Remarks:s: <br /> Signature: <br />