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k <br /> ' SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: q -00 <br /> Site :. $p(� <br /> Project No. : <br /> - Well Designation: <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? NO If no, see remarks <br /> Is well cap sealed and locked? NO IV If no, see remarks <br /> Height of well casing riser (in inches) : 2. <br /> Well cover type : 8 " UV _ 1211 UV 12" EMCO 8" BK <br /> 12 " BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 211 PVC bailer <br /> Dedicated bailer <br /> 4" PVC bailer Centrifugal <br /> —� g pump <br /> Sampled with: . Disposal bailer:-,X Teflon bailer: <br /> Well Diameter: 2" 411 611 g" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft. <br /> Initial Measurement <br /> Recharge Measurement <br /> Time : q 4 L. Time: Calculated purger 7 <br /> Depth of well : 7. Depth to water: Actual purge : d_ /r <br /> Depth to water :. <br /> E Start purge:� � Sampling time:_��3 <br /> Time Temp. E. C. pH Turbidity Volume <br /> E <br /> 74 F <br /> J <br /> 4 <br /> �D� 1D <br /> X6"3 ?03 �- 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: bock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature : <br />