Laserfiche WebLink
r <br /> SAMPLING INFORMATION SHEET <br /> Client_ - Sampling Date ' <br /> Site Project No <br /> Well Designationoil- <br /> Is setup of traffic control devices required?' YES time Is there standing water to the well box? 5 hours <br /> Above TQC Below TOC <br /> Is top of casing cut leve19 NO <br /> Is well cap sealed and locked If no,see remarks <br /> NO If no, see remarks <br /> ' Height of well casing user(in Inches) <br /> 12ell cover type 8"or12" C 12"LNI2"EMCO 8"or 12"BK 8"Chesty <br /> 12"M&D 12"DWP <br /> 12"CNI 36"CNI 12"Pomeco Other <br /> ' General condition of wellhead assembly Excellent Good Pau i <br /> Poor <br /> Purging Equipment 2"disposable bailer <br /> ._2"PVC bailer — - Submersible pump <br /> Dedicated bailer <br /> _4" C bailer Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer— <br /> Disposable Tubing_ <br /> Well Diameter 2" 4" 6" <br /> 8„ <br /> Purge Vol Multiplier 0.16 065 147 <br /> Initial Measurement Rechar a Measurement 2 61 gal/ft <br /> Tjme Time, ' <br /> Depth of well Calculated purge <br /> Depth to water. ,� Depth to water: Actual purge <br /> Start purge Sampling time _?7-' Zj <br /> Time Tem erasure E.C. <br /> 71A� (f 1 H Ttirbidi Volume <br /> 1Go f� <br /> Sample appearance A U616mw ' Lock; lye <br /> Equipment replaced: (check all that apply) Note condition of <br /> 2"Locking Cap' replaced item(s) <br /> Lock• 7/32 Allenhead <br /> 4"Locking Cap. Lock-Dolphin —� <br /> 6"Locking Cap ------ 9/16 Bolt <br /> Pinned Allenhead (DWP), <br /> Remarks l <br /> Signature <br />