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DOUL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> c7 <br /> Site:_ zE�3) I Project No. : <br /> �00 5 ,� _ Well Designation: w� <br /> Lo- C h <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 <ICEDIf no, see remarks <br /> Is well cap sealed and locked? NOg If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 1211 W 1211 EMCO 811 BK <br /> 12" BK 1211 DWP 1211 CNI 3611 CNI�X _ Other <br /> General condition of wellhead assembly: Excellent e6t7o3D Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer XCentrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 21° 411 611 801 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2. 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: Time: c Calculated purge: <br /> • Depth of ,well: El 9q_ Depth to water: 7 1 2 I Actual purge:�� � <br /> Depth to water-: 71 Ll <br /> Start purge: q O Sampling time: L Qa <br /> Time Temp. E.C. pH Turbidity Volume <br /> 3 • 7 q 7 S 7 3 FUM P o P_y <br /> 3.7 75 - 3 7 El --R— y PVM P p�r <br /> Sample appearance: Lock: Q <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 93753 : 7/32 Allenheads <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 61" Locking Cap: Panned A1lenhead (DWP) : <br /> Remarks: <br /> Signature: <br />