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©ODLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> _�- <br /> o client: LL��A..r�,c�ts� .. _ Sampling Date: 12 - 9q_ <br /> Site:_Pa.2a-Ge'''e 6 �_5 Project No. : Qy- 69 � -e� <br /> q 0 S _ Well Designation: rl w <br /> La-Z- , c 19 <br /> Is setup of traffic control devices required? N YES time: hours <br /> Is there standing water in well box? Y S Above TOC Below TOC <br /> Is top of casing cut level? O If no, see remarks <br /> Is well cap sealed and locked? NO� E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 W 1211 W 1211 EMCO 811 BK <br /> 12" BK 1211 DWP 1211 CNI 3611 CNI- ,K _ other <br /> General condition of wellhead assembly: Excellentoo Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer � X Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 211 4" 6P1 x 81° <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement 7 ^ <br /> Time: Time: ' r Calculated purge: <br /> Depth of well: Depth to water: 7 • 1s Actual purge:. KR . 7 <br /> Depth to water: 71 a <br /> Start purge: l j _�Q Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> ��•�� -79 I ( o 85 7 73 1 <br /> -7Y I oI3 7 I <br /> '3 � -7 J 1 n�- o 3 <br /> q <br /> Sample appearance: Lock: -'� <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 21f Locking Cap: Lock 93753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />