Laserfiche WebLink
SAMPLING INFORMATION SHEET <br /> Client : Sampling Date: `.aoL `00 <br /> Site : 50 Project No. <br /> Well Designation: <br /> Is setup of traffic control devices required? YES time: _ hours <br /> Is there standing water in well box? Y 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) : _ 2 <br /> Well cover type : 8" W 12" W 12" EMCO 8" BK <br /> 12 " BK 12" DWP_Wyo _ 12" CNI 36" CNI her <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment : 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2"4- 4" 6" 8" <br /> Purge Vol . Multiplier: 0 , 16 0 . 65 1 , 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time : 19139 Time:- 10111 Calculated purge : <br /> Depth of well : 6 Of qg Depth to water: 40.3-16 Actual purge: 4„, '' �- <br /> Depth to water; <br /> Start purge: le? 16 Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> 1y6e 7/.1 <br /> z,3 7 d a - - <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 /> Signature: <br />