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DOULO$ MMIRONNENTAL COMPANY SAMPLING INFORMATION SHEET <br /> r� Client: Sampling Date: 2 2 <br /> Site: Project No. :_ � <br /> Well Designation: r5 <br /> Is setup of traffic control devices required? <1[tP 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) : 4 . <br /> Well cover type: 8" W 12" tV 12" CO 8" BK <br /> 12" BK 12" DWP12" CNI - 36" CNI Other <br /> General condition of wel ead assembly: Excellent 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 It 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: I11 Time: 67 3 S Calculated purge: <br /> Depth of well: - Depth to water: Actual purge: ��Ll <br /> Depth to water: 6 7. 3 1 <br /> Start purge: � 17 Sampling time: 0-e) <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: -✓ Lock: 7 <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: _ �"' <br />