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- SAMPLING INFORMATION SHEET <br /> Client Sampling Date- <br /> Site Project No <br /> -3 fl Well Designation <br /> ' Is setup of traffic control devices required? N YES tune <br /> Is there standing water in the well box? .�_hours <br /> Is tap oCcasing cut]evel� Z6— Above TOC Below TOC <br /> Is well cap sealed and locked NO If no,see remarks If no, sec remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8"or 12"UV 12"EMCO 8"or 12"BK <br /> 12"Christy 8"M&D 12"M&D 8"Christy <br /> 12"CNI 36" CM IOt Other 12"Pomeco Other0 � <br /> General condition of wellhead assembly Excellent Good Fair <br /> Poor <br /> Purging Equipment _ 2"disposable bailer <br /> ' 2"PVC bailer Submersible pump <br /> Dedicated bailer <br /> —41?PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer � Teflon bailer <br /> _ Disposable Tubing_ <br /> Well Diameter- 2" a" 6" <br /> _ 8„ <br /> Purge Vol Multiplier 0.116 065 147 <br /> Initial Measurement Recharge Measurement 2 61 gaUft <br /> Time Time 9 .1 Calculated purge . <br /> Depth <br /> Depth tof well Z Depth to water' S- 63 Actual purge . ID <br /> o water , r�;a <br /> Start purge �� Sampling time <br /> r <br /> Time Tem erature E C. HTurbidi <br /> / I T � � Volume <br /> -12 <br /> /- <br /> i <br /> 1 � <br /> i <br /> Sample appearance �d-6* Lock <br /> Equipment rep aced (check all that apply) Note c <br /> 2"Locking Ca ondrtion of replaced items) <br /> Lock: 7/32 AIIenhead <br /> ' 4"Locking Ca _ Lock-Dolphin <br /> 6"Locking Ca 9/I6 Bolt <br /> Pinned Ailenhead (DWP) — <br /> Remarks 't <br /> Signature <br /> r <br />