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Sir ;. <br /> DOOL08 ENVIRONMENTAL COMPANY INFORMATION SIFT <br /> Client:li,�ty,� Sampling Date: 'C)o_ _ <br /> Site: all_L�_ Project No. : <br /> } 1 �� Well Designation:Z, W ' C <br /> GA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? @ YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: S" W 12" W 12" kMC0 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI therL;'M­"'�)_ <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> II I II I IIIY Y1.1 ^ �rl�l�PI <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer:_ Teflon bailer : <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1 . 47 2 . 61 gal/ft. <br /> Initial Measurement Recharcre Measurement <br /> Time: 16-06 Time: Calculated purge : <br /> Depth of well : NJ On — Depth to water: Actual purge • W UI 1 <br /> Depth to water: 3-1 �-1 <br /> Start purge: Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 5 I d'¢l� <br /> 0 6 Cl 714 <br /> Sample appearance: CAIP__ / Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced iter <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt <br /> 6" Locking Cap: Pinned Allenhead (DWP) . <br /> Remarks : <br /> Signature: <br />