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DOQLOG NWIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: 6 <br /> Ic(s�-y��, -�-C �GI Project No. <br /> Site; '. <br /> r160 S Well Designation: /OW-36 <br /> \ ! /J <br /> Is setup of traffic control devices required? CO YES time: hours <br /> Is there standing water in well box? JRYES Above TOC Below TOC <br /> Is top of casing cut level? 0 Z%'P9If no, see remarks <br /> Is well cap sealed and locked? O If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV12" 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI__y 36" CNI O her <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer 2� Centri€ugal pump <br /> Sampled with: Disposal 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 Recharge Measurement <br /> Time: IIA, Time: /� Calculated purger <br /> Depth of well: ) 3b Depth to water: Actual purge: � �{ <br /> Depth to water:Ck.3 <br /> a <br /> Start purge: /1 Q Sampling time: /�D <br /> Time Temp. E.C. pH Turbidity Volume <br /> r-�- <br /> �ja� '2, �Z' <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 /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: 00, <br />