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SAMPLING INFORMATION SKEET <br /> Client : Sampling Date: co <br /> Site : 5OQ Project No. : <br /> Well Designation: o <br /> Is setup of traffic control devices required? YES time : hours <br /> Is there standing water in well box? <br /> Is top of casing cut level? Y Above TOC Below TOC <br /> IqO Is well cap sealed and locked? If no, see remarks <br /> Height of well casing riser (in inches) : NO If no, see remarks <br /> Well cover type : !1 } <br /> 12 " BK yp 8 UV y _ 12 W 12" EMCO 8" BK <br /> 12 " DWP 12 " CNI 36" CNI Cher <br /> General condition of wellhead assembly: Excellent bo Fair Poor <br /> Purging Equipment: 21° disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter : 211 4�� 611 $„ <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 61gal/ft . <br /> Initial Measurement Recharge Measurement <br /> Time -_ cq Time :_ (,� Calculated purge :1m <br /> Depth of well : Depth to water: Actual purger <br /> Depth to water : r� <br /> Sart purge : t� 7 Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> r r� t� 1 <br /> F . <br /> Sample appearance : Lock: <br /> Equipment replaced : (Check all that apply) Note condition of replaced iter <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 />