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DOULOG ENVIRONXENTAL COMPANY SAMPLING INFORMATION SHEET <br /> p <br /> Client:- 1Af&0UV0k/t' ' Sampling Date: <br /> Site: 6q Project No. : - 01 <br /> evo, L4A41-4r" Well Designation: ►• Y �'� �O <br /> 64 . <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? NOIf 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: 8" UV 12" UV 12" EMCO 8" BK <br /> 1211 BK 12" DWP� 1211 CNI 36" GNIer <br /> General condition of we lhead assembly: Excellent o Fair Poor <br /> Purging Equipment: X_2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:, Teflon bailer: <br /> Well Diameter: 211-JK 4" 6" 811 <br /> _ <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> Time: Time: ` Calculated purge: 1• <br /> Depth of well: 5 Depth to wa er: 6 - 6f Actual purge:� _�m <br /> Depth to water: <br /> Start purge: Sampling time: .��a� <br /> Time Temp. ---E.C. pH Turbidity Volume <br /> N7 . IV S 12 <br /> 76. 7 a 2 7,91 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: 4WA IA�4,A_ <br />