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R; <br /> 1>0 L08 ENVIROMMNTAL COXPJWY SAMPLING INFORMATION SHEET <br />' Client: Sampling Date: <br /> Site : Project No. : <br /> / 600 CS, LQJ=Zaf1Rd Well Designation: M W Df <br /> /-g 'fA Lao , G A. <br /> Is setup of traff is control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below Toc <br /> Is top of casing cut level? qP <br /> Xf no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : ._ <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12'� CNI,_.�36" CNI her 1�� f <br /> General condition of wellhead assembly: Excellent � Fair Poor <br /> Purging Equipment; 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: eflon bailer: <br /> W-Well Diameter: 211 411 6" 811 <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1, 47 2 . 61 gal/ft . <br /> Measurement <br /> 1 . Time: Time: < 9`OCalculated purge: <br /> Depth of well : D Depth to water; • 90 Actual purge :LQ_^�C' <br /> Depth to water: <br /> Start purge; Sampling time: f o'er <br /> Time Temp... E.C. pH Turbidity Volume <br /> =3 � 7 Ll 7 7 - <br /> I Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #37531 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> I <br /> . Remarks: <br /> Signature; <br />