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DOUL08 ENV'I,ROpp..N��MENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client : Sampling Date*_/� <br /> Site Pro3ect No <br /> /21 /0 E mL Well Designation• //n w — S <br /> G <br /> Is setup of traffic control devices required' YES time * <br /> Is there standing water in well box? hours <br /> T <br /> Is top of casing cut levelsNO <br /> Y S Above OC Below TOC <br /> Is well cap sealed and locked) NOIf no, see remarks <br /> Height <br /> NO E If no, see remarks <br /> of well casing riser (in inches) : <br /> Well cover type : 8" UV 12" UV 121' EMCO 8" BK <br /> 12 " BK "" -?-r CNI CNI <br /> General conditionDof wellhead�Assembly: Excellent oo herFair Poor <br /> Purging Equipment: 2" disposable bailer x Submersible pump <br /> 2 PVC bailer Dedicated bailer <br /> 41' PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer:__ Teflon bailer <br /> Well Diameter: 21' 4u X 6„ 811 <br /> Purge Vol Multiplier: 0 16 0 . 65 1. 47 2 61 gal/ft <br /> n I t al Measureme t "Recharge Measurement <br /> Time © Time : O , Calculated �S <br /> Depth of well . 13 0 -7 Depth to water: _ Purge <br /> Depth to water • 3 - '7 Actual purge S <br /> Start purge . /0 '_ oj'_ Sampling time :_.L0 � <br /> Time Temp. E. C. pH Turbidity Volume <br /> /0 ' 0-7 3 7 - --�-� <br /> tot / G7 / 112D ?. y� <br /> /o ` i 4-7- 2 It 6/ 0 7- 3,28 <br /> Sample appearance: <br /> Lock- <br /> 7 <br /> (rL <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock #3753 : � 7/32 Allenhead - <br /> 4 Locking Cap: Lock-Dolphin: <br /> 6" Locking Cap: 9/16 Bolt <br /> Pinned Allenhead (DWp) <br /> 40 Remarks <br /> Signature <br />