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DOUL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date:_ ff 'Z <br /> Site• a 13 d Project No. : <br /> ZqO6' -lam 9Z _. 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 lever NO If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV 1.2" EMCO 8" BK <br /> 12" BK 12" DWP � NIK 36" CNI Other <br /> General condition of wellhead assembly: Excellent (!!� Fair Poor <br /> Purging Equipment: 2" disposable bailert Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: S_:e Teflon bailer: <br /> Well Diameter: 2" 4"A 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft <br /> nItialMeasurement Re har easurement <br /> Time: 9 3 g L Time: Calculated purge: <br /> Depth of well : ^7 Depth to water: 1 6 Actual purge; <br /> Depth to water: <br /> Start purge: = Sampling time: ° (C� <br /> Time Temp. E. C. pH Turbidity Volume <br /> 7S �{ 6� <br /> 6 5 � v 3 <br /> Sample appearance: GamLock: �`�71 / 7- f- <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock , 3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature - <br />