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65/19/2068 08:02 9167829654 DDULDS PAGE 08 <br /> SAMPLING INFORMATION SHEET <br /> Sampling Date: S <br /> Sita _ $OQ.�/ 'dC . Project <br /> Well Designation: -7 <br /> Is setup c,' traffic contx-ol devicesrequired? C <br /> Is there sanding water in well box? time: <br /> Is top of casing cut level? NO YES Above T( C ow'TO <br /> Is well cap Sealed and locked? NO If no, See remar s <br /> Height of . ill .:asi.ng riser No � If no, see remarks <br /> well cover t (in inches) : 3 <br /> rr YPe; 8" W 12" CN <br /> 12 13K - �� — 12" EMCO 811 BX <br /> General conditienDof wellhead'Tassemb CNI Exce11 lleOther <br /> nt aOOT) <br /> Fair Poor <br /> Purging Equlpii��nt : 2" disposable bailer <br /> Submersible <br /> 2" PVC bailer �-. pump <br /> -411 PVC bailer <br /> bailer <br /> centrifugal pump <br /> Sampled with: Disposal bailer: <br /> Teflon bailer: <br /> Well Diameter: 2" Ort <br /> 6 rr $rt <br /> Purge Vol . Multiplier: 0. 16 <br /> I n,1t ' 1 Meas 0. 65 1. 47 2 . 61 gal/ft. <br /> �u ement Re r easure nt <br /> Time:__ <br /> Depth of well : S- Time: <br /> epth to water; . Calculated Purge.- 11 - <br /> Depth to water: D- Actual purge: � <br /> Start Purge, r- 1 � Sampling time• S s <br /> Time Temp. E.C. PH Turbidity Volume <br /> 50 <br /> i <br /> Sample appearance: Lock: M T <br /> 2" Locking ng. <br /> Equipment r -a: (check all that apply) Note condition of replaced item <br /> Ca Cap: ppY) <br /> 4" Locking Cap:__ Lock #3753 :� 7/32 Allenhead: <br /> 6" Locking cap:_ — Lock- Dolphin• 9/16 Bolt: <br /> ~- Pinned Allenhead (DWP) :—, <br /> Remarks: <br /> Signature: <br />