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r <br /> 1>0UL08 ENVIRONXENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client• Sampling Date: <br /> r S ite: g&&r= Mae � eZ-94 - Project No. : <br /> / n Ad Well Designation: w 5 <br /> tM <br /> Is setup of traff is control devices required? 10 YES time : hours <br /> is there standing water in well box? YES Above TOC Below TOC <br /> is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK <br /> 1 <br /> 1211 BK 12" DWP 1211 CNI_ 3611 CNI Other <br /> General condition of wellhead assembly: Excellent o� Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> 1 <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2"X 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1, 47 2 . 61 gal/ft <br /> 1 surement Recharge Measurerpent <br /> Time: Time: t L ' .1 Calculated purge : <br /> Depth of well : 1 b ' I3 Depth to water: - • S Actual purge <br /> Depth to water:, <br /> Start purge: �_ ' y Sampling time:,_,,, t 1 <br /> 1 <br /> Time Temp. _ E.C. pH Turbidity Volume <br /> L46 <br /> 2• r 1 l 2_ �� � 1 � --- � <br /> 1 101 ---------?J <br /> i <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt . <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> I <br /> Signature : � <br />