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SAMPLING INFORMATION SKEET <br /> Client Sampling Date <br /> Site Project No. _ <br /> Well Designation <br /> is setup of traffic control devicos required? Q6 YES true hours <br /> Is thcre standing water m the well boxy KZ YES Above TQC Below TOC <br /> Is top of casing cut level? NO If no,see remarks <br /> Is well cap scaled and locked? NO If no, aec romarks <br /> Height of well casing riser(in inches) <br /> Well cover We 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12"Christy8"M&12X _ 12"M&D I2"DWP <br /> 12"CNI 36"CNi_ 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good _ Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4" VC bailer Centrifugal pump <br /> Sampled with Disposable bailer__ _ Teflon bailer Disposable Tubing__ _ _ <br /> Well Diameter' 2" 4" 6" $" <br /> Purge Vol Multiplier- 016 065 1.47 2 61 gal/ft <br /> Initial Measurement &2harge Measurement <br /> Time !J3-5---- Time 16 141 Calculated purge a, od <br /> Depth of well Depth to water: _ 2 Z.7 7 Actual purge �L,14 JJ <br /> Depth to water I-1 t <br /> Start purge 100 Z Sampling time <br /> Time Tein erature E C H Turbidity Volume <br /> Q �-�• <br /> /aD �-O. 16 7ri 731 , <br /> Sample appearance Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> eP ( ) <br /> 2"Locking Cap, Lock, 7132 AlIenhead <br /> 4"Locking Cap, Lock-Dolphin, 9/16 Bolt <br /> 6"Locking Cap Pinned Allenhead (DWT) <br /> Remarks 1 <br /> Signature <br />