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SAMPLING INFORMATION SHEET <br /> Client : Sampling Date : <br /> Site : <br /> Project No. : <br /> Well Designation: <br /> Is setup of traffic control devices required? YES time : <br /> Is there standing water in well box? 9 hours <br /> Is top of casing cut level? YES Above TOC Below TOC <br /> Is well cap sealed and locked? NO IV If no, see remarks <br /> Height of well casingriser YES If no see remarks <br /> (in inches) : . <br /> Well cover type : 8"" UV 121" UV 1211 EMCO <br /> 1211 BK 12 '" DWP 12" CNI $r' BK <br /> General condition of wellhead assembly: Excellent pother/y" <br /> Fair Poor <br /> Purging Equipment ; 2 " disposable bailer <br /> Submersible pump <br /> 21" PVC bailer Dedicated bailer <br /> 41" PVC bailer Centrifugal pump <br /> Sampled with : Disposal bailer: Teflon bailer: <br /> Well Diameter: 2""X 411 Err 811 <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 , 61 <br /> Initial Measurement <br /> Bechar e Measurement <br /> Time : Time : /�32. Calculated purge : , c <br /> Depth of well : Depth to water : 41,06 Actual purge : S dr <br /> Depth to water: <br /> Start purge : 12Ij0 Sampling time: / <br /> Time Temp. E. C. pH Turbidity Volume <br /> ----- I <br /> Q 4 7 �O f <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 /> Signature : <br />