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j <br /> { SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: �f►�1�-`D� <br /> site 500 <br /> Project No. <br /> Well Designation: Iiij` <br /> a <br /> Is setup. of traffic control devices required? O <br /> Is there standing water in well box? q 0 YES time: hours <br /> 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 Tn If no, see remarks <br /> Height o'f well casing riser (in inches) : <br /> Well cover type : 8" UV 12" W 12" EMCO 8" BK- <br /> 12 11 BK -- 12" DWP k 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: -y— Teflon bailer: <br /> Well Diameter: 2" 411 611 811 <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal/ft, <br /> Initial Measurement Recharge Measurement <br /> Time : gL S' Time . II L3 Calculated purge: 7 � <br /> Depth of 'well : Depth to water: Actual purge : <br /> Depth to .'water : <br /> Start purge :_41 13 Sampling time: Z <br /> Time Temp. E. C. pH Turbidity Volume <br /> 1� , 1, r� <br /> ll `17 7d� � � <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 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 />