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SAMPLING INFORMATION SHEET <br /> Client: Sampling Date : ����-'moo <br /> Site . <br /> re Project No. : <br /> Well Designation:.rY�� <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) ; <br /> Well cover type : 8" UV 12 " UV 12" EMCO 8" BK <br /> 12 " BK 12 " DWPYV" �- 12" CNI 36" CNI ther <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" 611 811 <br /> Purge Vol . Multiplier : 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time : Time : / Calculated purge ?-144t <br /> Depth of we 11 : 51-O_ Depth to water: It j9> Actual purge : G�- <br /> Depth to water :_Itb6f, <br /> Start purge : Z03 14 sampling time: `d <br /> Time Temp. E. C. pH Turbidity Volume <br /> d <br /> IN <br /> Sample appearance : Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced iter <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 />