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SAMPLING INFORMATION SHEET <br /> Client : Sampling Date: <br /> Site : 50O_. Project No. <br /> Well Designation: liV^L f <br /> Is setup of traffic control devices required? NO YES time: hours <br /> Is there standing water in well box? YES 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) : 3 <br /> Well cover type: 8" UV 12" UV 12" EMCO 8'" BK <br /> 12" BK 12 " DWP 121" CNI - 36" CNI Other <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 Y Centrifugal pump <br /> Sampled with: Disposal bailer:_ Teflon bailer: <br /> Well Diameter: 2"-,A— 41" 61T g"" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1. 47 2 . 61 cral <br /> Initial Measurement Recharge „Measurement <br /> Time : {�- _ <br /> � Time : 11,56 Calculated purge <br /> Depth of well : Depth to water: Actual purge : d•3 .� <br /> Depth to water:_J�_ lj - <br /> Start purge : LEY— Sampling time: y <br /> Time Temp. E. C. pH Turbidity Volume <br /> -710 <br /> 11 _ 710 <br /> 1153 70. , - 70?' <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 /> 61" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> 00, <br /> r` <br /> Signature : V.-Od, =_ <br />