Laserfiche WebLink
DOQLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: <br /> Sampling Date:- ig /-;2 <br /> Site: 06qProject No. : <br /> 0 0 dm'a- <br /> Well Designation: . , <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? NO3 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV_ 12" UV12" EMCO 8" BK <br /> 12" BK 12" DWP_ �< _ 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent o Fair Poor <br /> Purging Equipment: 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: 2"_/X_ 4" 6" 'S81- <br /> Purge <br /> "Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar a Measurement <br /> Time: 9 - I �_ Time: 2- Calculated purge: 0 6 <br /> Depth of well: 6 Depth to water: - Actual purge: <br /> Depth to water: <br /> Start purge: �. l� Sampling time: 11. 3 0 <br /> Time Temp. E.C. pH Turbidity Volume <br /> zo I �� 3 <br /> 737 <br /> t <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: <br /> : r <br />