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} r�rr 'r.a . rlt r , ,,%�¢ici ',{r i ' �ir�lr•r sr,� <br /> 1 <br /> s <br /> 1>0IIL08 ENVIROWENTAZ COXVA" r SAMPLING INFORMATION SHEET <br /> Client: t -o <br /> z r Sampling Date., 1 2'�� _Z <br />!� Site: A2g=L Project No. : <br /> S <br /> i n Well Designation: - 3 <br /> 1 Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? O YES If no, see remarks <br /> Is well cap sealed and locked? NO ES If no, see remarks <br /> Height of well casing riser (in inches) ; <br /> Well cover type: 8" UV121' LTV„ ,._,,,_ 12" EMCO 8" 5K <br /> 1 <br /> 1211 BK 1211 DWP 12" CNI� 3611 CNZ other_?►�!L�1^ 5 <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: _2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> 1 <br /> sampled with: Disposable bailerUcr Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 26 0, 65 1. 47 2 . 61 gal/ft. <br /> 1 i Initial Measur2m2nC� <br /> Time:.40-0.5: Time; = Calculated purge : <br /> Depth of well : 47. 7% 6 Depth to water,,-/ ./d Actual purge <br /> Depth to water: 10..4_ <br /> r Start purge : /Q - -- Sampling time: 10 Z44 02 <br /> Time Temp.... E.C. pH Turbidity Volume <br /> Sample appearances Lock: _k1 ZIA <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753s 7/32 Allenhead: <br /> 411 Locking Cap: Look--Dolphin: 9/16 Bolt: <br /> I 6" Locking Cap: Pinned Allenhead (DWP <br /> • Remarks : <br /> i <br /> Signature : �r <br />