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SAMTL]NG INFORMATION SHEET �/l` c <br /> //'/ ta�vlw+Smer�faE <br /> oesultants,Enc. <br /> Sample ID# �� L Project Name: Project No <br /> ��oc�aaon {address) <br /> r <br /> ' Dam SaMpled: _a'L ! <br /> !W#9hea tXssembly comdiuon• GOO Fair Poor(If poor, See comments) <br /> Eqt i ent Replaced: bolts locks loclang cap <br /> e W Oepth 3 _ ft below top of caste Casing diameter incites <br /> itff to water(below top of casmg) Z- ft_ Date: <br /> _1_1_ Tune _ <br /> WelrCfi acing Volume Multiplier: 0.16 for 2", 0 65 for 4", 1.47 for 6" <br /> i `ftikffig method: Submersible pump Baer Centrifugal pump Other <br /> At least well volumes have been evacuated before sampling. <br /> Tubing(type: ._fir ). (new or previously used) was used to purge well <br /> Sampling method_ Disposable barer $ampUmg port <br /> Samples collected Sample appearance- <br /> Note <br /> ppearanceNote any samphng problems <br /> . GROUND WATER EVACUA'nON/STABII.MATION DATA <br /> Cumuiauve Volume of <br /> " w Conductance Water Level Water Removed from Well <br /> Time s Tem Tatum (°F) PH Units (umxtoslrm) (Nearest 0.01 R) (gallons) <br /> Y <br /> Commenw. <br /> Trnsportation(th=wd pieservatton) <br /> Form completed by: Sampled by: <br /> 5 <br />