Laserfiche WebLink
DOUL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: f RProject No. : �'!1}- 69 c-f21 <br /> i„�a�_, 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? O If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 W 1219 W 12" EMCO 819 BK <br /> 1211 BK 1211 DWP 1211 CNI X -- 3611 CNI Other <br /> General condition of wellhead assembly: Excelleiit_0'0'�OA Fair Poor <br /> Purging Equipment: X241 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:.,_ Teflon bailer: <br /> Well Diameter: 2" 499 611 See <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />! Time: I1O 5 Time: 5 8 0 Calculated purge: 17 <br /> Depth of well: i Depth to water: actual purge: 1- :7 <br /> Depth to water: 7 <br /> Start purge: Sampling time: 5 5 1-1 �.— <br /> Time Temp. E.C. pH Turbidity Volume <br /> I If 3 6 7 2,k /// 7 <br /> 3145 6 <br /> X147 cC-0 �_ 3 <br /> 350 6 s. 7 7, �?Q �. <br /> Sample appearance: f'162_ Lock: - <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 249 Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 499 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 60 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: Adfl�� <br />