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SAMPLING INFORMATION SHEET <br /> Client Sampling Date- <br /> Site Project No - <br /> v t Well Designation <br /> Is setup of traffic control devices required? YES <br /> Is there standing water in the well box? <br /> e -- -----bow <br /> Is top of casing cut level? Above TOC Below TOC <br /> Is well cap sealed and locked N0 If no, see remarks <br /> NOIf no,see remarks <br /> Height of well casing Hier(m caches) 15 <br /> Well cover type 8"or 12"CIV 12"$MCO 8"or 12"BK <br /> ' „ 8"Christy <br /> I2 Christy 36 CNID� 12"M&D t2"DWP <br /> 12"CNl 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good <br /> Pair Poor <br /> Purging Equipment 2" disposable bailer <br /> 2"PVC bailer Submersible ptlmp <br /> 4" VC bailer _ Dedicated bailer <br /> Sampled with Disposable bailer� — Centrifugal pump <br /> Teflon bailer Disposable Tubmg, . <br /> WeII Diameter- 2" 4„ 6„ <br /> _ Purge Vol Multiplier' p g" <br /> Initial Measurement 065 147 —� <br /> Re har a Measurement 2 61 gaVft <br /> ` Time Time <br /> Depth Aowellp `] Calculated purge <br /> De <br /> pth to water 23i Depth to water; L Actual purge �, <br /> O <br /> Start purge _ /Q)L6 Sampling time <br /> ` Time Tem erature E C H <br /> Turbidit Volume <br /> /0)- 3 <br /> Sample appearance Lock <br /> Equipment re <br /> placed. (check all that apply) Note condition of replaced item(s) <br /> 4" Locking Cap Lock-D <br /> 2" Locking Cap Lock- in 7132 Allenhead <br /> ' olph--- �- <br /> 6" Locking Cap Pinned Ailenhead (DSI 6 Bolt <br /> Remarks ) <br /> Signature <br /> f <br />