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SAMPLING INFORMATION SHEET <br /> Client : Sampling Date- q��'-��00 <br /> Site : 50 Q. Project No. : <br /> Well Designation:—MW-3 <br /> 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? P If no, see remarks <br /> Is well cap sealed and locked? 0 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type : U" UV 12 " UV 12" EMCO a" BY <br /> 12" 6K 12 " DWP_::�5' _ 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellentoc Fair Poor <br /> Purging Equipment : 2 " disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4 " PVC bailer _ .X Centrifugal pump <br /> Sampled with : Disposal bailer: - -;Y Teflon bailer: <br /> well Diameter: 2" 411 6" <br /> Purge Vol . Multiplier: 0 . 16 <br /> 0 , 55 1 . 472 . 61 gal,ft . <br /> Initial Measurement Recharge Measurement <br /> Time : o Time : 1,2111, Calculated purge <br /> Depth of well : Depth to water: Actual purge : a.. � <br /> Depth to water: a(,15 <br /> Start purge : Sampling time: 1 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 113 <br /> 13 <br /> >d.-q 6f, -� 3 <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 />