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' SAMPLING INFORMATION SHEET <br /> Client Sampling Date •L A-� <br /> Site Project No <br /> 41!1111 Well Designation <br /> Is setup of traffic control devices required YES time <br /> Is there standing water in the well boxy hours <br /> Above TQC Below TOC <br /> Is top of casing cut levels NO EM <br /> ' Is well ca If no,see remarks p sealed and locked? NO E If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8" or 12"UV 12"EMCO 8"or 12"BK <br /> $" Chris <br /> E 2"Christy8"M&D 12"M&D 12"DWP Ty <br /> 12" CNI 36"CNI 12"Pomeco Other f2s��S <br /> General condition of wellhead assembly Excellent Good_ <br /> Pau Poor <br /> Purging Equipment 2"disposable bailer <br /> Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer , Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" <br /> g„ <br /> Purge Vol Multiplier 016 065 147 <br /> 2 61 gal/ft <br /> Initial Measurement <br /> Recharge Measurement <br /> Time - <br /> TimeDeptof ilk Time t f Calculated purge <br /> Depth to water Actual purge Z.Q <br /> Depth to water 3 - <br /> Start purge ' 0 Sampling time ZS <br /> Time Tem erature E C H Turbidit Volume <br /> 77 0 .�. <br /> Sample appearance P1- Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2"Locking Cap Lock 7/32 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Balt <br /> 6" Lacking Cap Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />