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SAMPLING INFORMATION SHEET <br /> Client : <br /> Sampling Date : 00 <br /> � site : 50 Q.. ' <br /> Project No . : <br /> Well Designation : 57 <br /> Is setup of traffic control devices required? T�O YES time : <br /> Is there standing water in well box? 4 hours <br /> Is top of casing cut level? � Above TOC Below TOC <br /> Is well cap sealed and locked? NO �EL9 If no, see remarks <br /> Height of well casing riser (in inches) : YES If no, see remarks <br /> Well cover type : 8" W 12 " W <br /> 12 " BK 12" DWP 12" EMCO 8" BK <br /> 12" CNI 36" CNI Other I'o <br /> General condition of wellhead assembly: ExcellentFit) Fair Poor <br /> Purging Equipment: 2 " disposable bailer <br /> „ Submersible pump <br /> 2 PVC bailer Dedicated bailer <br /> 4 " PVC bailerCentrifugal pump <br /> Sampled with: Disposal bailer ; Teflon bailer : <br /> Well Diameter : 2" z2 4,r <br /> Purge Vol . Multiplier: 0 . 1.6 yy 0 . 65 1. 47 2 . 61 gal/ft . <br /> 4 Initial Measurement Recharge Measurement <br /> Time : 1(703 Time ., Calculated purge : 7 <br /> Depth of weft : 7-3 Depth to ater :__� <br /> Depth to water: Actual purge : rJ� <br /> "'"` <br /> start purge :_/ � �] Sampling time : /4,jf, <br /> Time Temp. E. C. pH Turbidity Volume <br /> I 70,E 7JI <br /> Sample appearance : Lock : <br /> Equipment replaced : (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4 " Locking Cap: Lock-Dolphin: 9/16 Bolt : <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature : <br />