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• DOOL06 ENVIRONMENTAL COMPANY SAMPL_ ',, x INFORMATION SHEET <br /> Client: Ck4a-- Sampling Date (,� —L6- 00 <br /> Site: a Project No <br /> 7506 AA f,40 Well Designat o,i W -' <br /> Is setup of traffic control devices required? YES tame: 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) : <br /> Well cover type: 6" UV_„_.,_^_ 12" W 12" EMCOB" BK� <br /> 12" HK_ 12" DWP_ 12" CNI_ 36" CNI Other _ <br /> General condition of wellhead assembly. Excellent qCT�)u d Fair Poor <br /> Purging Equipment: 2" disposable bailer _ Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br /> Sampled with: Disposable bailer:s,r Teflon ba_- E#r. <br /> Well Diameter: 2" 4" 6" 8 i <br /> Purge Vol. Multiplier: 0. 16 0.55 1. 47 61 gal/ft. <br /> s <br /> Time: X= 4 k ._ Time : Calcu_fired purge: ' <br /> Depth of well• 4- W Depth to water: 0 Actual Purge: <br /> Depth to water.- <br /> Start <br /> ater:Start Purge: / p O Sampling time: O = s' "= _ <br /> Time Temp. E. C. pH Turbidity Volume <br /> Sample appearance: Lock: - '� ti E <br /> Equipment replaced. (Check all that apply) Note condition of replaced item <br /> Zr' Locking Cap: Lock #3753 : 7/32 Allenriead: <br /> 4+' Locking Cap: Lock-Dolphin: 9/16 Bolt:^ <br /> 6" Locking Cap: Pinned Ail.enhead (OWP) : <br /> Remarks: <br /> Signature: _ <br /> I <br /> 90 39VJ so-inoa b506ZeL9T6 eb 6e 0002/bZ/e0 <br />