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1 <br /> 1>0UL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> • Client: Sampling Date: /a.-:0-06 <br /> Site: o� l� ��, Project No. : <br /> 1-0 <br /> - �„ <br /> /S" n Well Designation: <br /> Z <br /> Is setup of traffic control devices required? YES time: hours <br /> o <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) ': 31, <br /> Well cover type: 81, W 12 It W 1.2" EMCO .� 8" <br /> 12" BK 12" DWP 1211 CNI 36" CNI 0then <br /> General condition of wellhead assembly: Excellent ao Fair Poor <br /> Purging Equipment: <br /> g 9 _211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 41' PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 211 -)( 4" 6" 8" <br /> Purge Vol . Multiplier: 0. 16 0, 65 1., 47 2 . 61 gal/ft. <br /> iinitial Megsuremement <br /> Time: Time: X Calculated purge: S <br /> Depth of well :/9, 7 t Depth to water:_I L2 Actual purge , <br /> Depth to water:_-4,2_!j <br /> Start purge: Il 05 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> /'6'� 67- 1 1311, 701 <br /> 1/107 166 2. l2-77 69$' Q_ <br /> Sample appearance: <br /> S�—� Lack <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 /> Signature : <br />