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b=os ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client. Sampling Date: �~ <br /> • Site: ` Proj ect No. I---C <br /> _r, <br /> Well Designation: 0i; .� r <br /> .. _ -..,_.rte,=., q • '.'�-s�,���':I'F.�.'"✓ ''c <br /> Is setup: of traffic control`-devices required? Q YES time: hours <br /> Is there _standing water .in well box? No Above TOC y ow C <br /> Is top'--of casing` cut,Ylevel7 N if no <br /> x - ;. , see rem s <br /> Is well cap sealed and "locked? = " ; _: O YE If no see remarks <br /> Height of well casing_'rses :(in--inches) : /j <br /> Well cover.. type: 8" L z; - f_.` '12" <br /> 'UV 12" EMCO g n BK <br /> 12" BK _ 12.!! DWP`: .12!' CHI: ,wr 3611 CNI Other' C nza <br /> General conditionJ'of.`wellhead- 'assembly: Excellent Good Fair Poor <br /> Purging Equipment: ' - 2+� <br /> * v "_ „. disposable bailer Submersible pump <br /> 2, , PVC bailer. Dedicated bailer <br /> ti t_ 4 PVC :baler:' Centrifugal pump <br /> Sampled`with: Didposal bailer. <br /> P — _ Teflon bailer: <br /> Well Diameter..` 2" 4++ 611 81+ <br /> Purge Vol: Multiplier•-z 0 16. " . 0. 65 1. <br /> _.. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: L1 _ ...:.::�::: �;,_._ . <br /> .y '-`s -'.y Time: 6. Calculated 17 <br /> De th-• of,,well: = purge: f.j <br /> P ,Y. ^� ' Depth to water: � !,01 Actual purge: 11j — <br /> Depth to water: .�'c9•R' =: :� :�;3 4 <br />•Start purge• Ei _ Samplin^sg time: <br /> Time Temp.:. E.C,:" pH Turbidity Volume <br /> 7. <br /> 71 <br /> Sample aPpP•earanceT ;: _ <br /> Lock: <br /> Equipment. replaced: (Check all that apply) Note condition of replaced item <br /> L <br /> 2" Locking .Cap: ' ock , 3753 : P <br /> _ . .� 7/32 Allenhead: <br /> 411 Locking Cap:. = „ Lock Dolphin: 9/16 Bolt: <br /> 6" Locking / ---- <br /> Ca P� rt Pinned Allenhead (DWP) : <br /> Remarks: <br /> '61Q; <br /> 6 y-'7:. <br /> , <br /> - r as- .. 4 ,;,4N.�MY%}`• c ryu .t'..- <br /> . atllre: w <br /> e <br />