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DOULCB ENVIRONMENTAL COMPANY SAMPL-N INFORMATION SKEET <br /> Client; Sampling Date ` r�� <br /> site• _ a /3 Project No. <br /> 7126 Well Deszgnat;,or w <br /> ` Is setup of traff is control devices required? YE.' tame- hours <br /> Is there standing water in well box? ' YE.S Above Toc Below TOC <br /> Is top of casing cut level? No (:7M If no, see remarks <br /> Is well cap sealed and looked? No If no, see remarks <br /> Height of well casing riser (in inches) : <br /> well cover type: 8 11 UV 12" UV 12 EMC_T�T <br /> 1211 8K 1211 DWP hal CNS � 3611 CNII t�i=der <br /> General condition of wellhead assembly: Excellent ff'r7r,-U Fair Poor <br /> Purging Equipment: 2" disposable bailer I_.;vamersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer _—Centrifugal pump <br /> Sampled with: Disposable bailer;_aLETeflon ba -F,Y <br /> Well Diameter; 211 4"-4- 611 q„ <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 _ 61 gal/ft. <br /> Int <br /> -7 <br /> Time: Time: ali:LL_ated purge:_73i <br /> i <br /> Depth of well: '7Z- &5 Depth to water: 3 9, 9 ,actual purge: <br /> Depth to water, 37CJ <br /> Start purge: f I%;_ Sampling time: ,1 <br /> t Time Temp. E.C. pH Turbidity Volume <br /> I I o T S- <br /> �f ( tD- q <br /> 10- 30 <br /> i <br /> Sample appearance: Lock: y'U <br /> Equipment. replaced: (Check all that apply) Mote conditicn of replaced item <br /> 2T' Docking Cap: Look #3753: / 32 Allenhead• <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking cap: Pinned Ailennead (DWP) ; <br /> Remarks; <br /> Signature: <br /> G0 39VJ so-inoa V906Z8L9t6 8b 60 000Z/VT/60 <br />