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SAMPLING INFORMATION SHEET <br /> Client : - Sampling Date: <br /> Site 500 <br /> Project No. <br /> Well Designation; IL <br /> -6 <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? IR 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) : <br /> Well cover type: 8 " UV 12" UV 12" .EMCO SE' BK <br /> 12" BK 12" DWP� 12" CNI 36" CNI ther <br /> General i,condition of wellhead assembly: Excellent Lo o) Fair Poor <br /> i <br /> Purging 'Equipment : 2" disposable bailer Submersible pump <br /> 2" PVC bailer . Dedicated bailer <br /> 4 " PVC bailer Centrifugal��---- gal <br /> Pump <br /> Sampled with: Disposal bailer: 4� Teflon bailer: <br /> Well Diameter: 2"- 4" 6" 811 <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1. 47 2 , 61 gal;ft. <br /> Initial Measurement Recharge Measurement <br /> Time: ql��j` Time:_1.4" Calculated purge: s.7 <br /> tod <br /> Depth ofwell : Depth to water: 3 Actual purge : <br /> Depth to;, water: 42.•3,1„ <br /> Start purge .-_/13t) Sampling time• <br /> Time Temp. E. C. pH Turbidity Volume <br /> m z 7.4 <br /> k 1 7 6 3 YiO <br /> E <br /> E <br /> Sample appearance : Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2 Locking Cap: sock #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 />