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DOaLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> . Client: ��1ut�� _ Sampling Date:- - IP - 00 <br /> Site S / Project No. : <br /> mL Well Designation: Y" w `� <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? NO If no, see remarks <br /> Height of well casing riser (in inches) : ._- 3 <br /> Well cover type : 8" W 12" W 12 " EMCO 8" BK <br /> 12 " BK 12 " DWP 12 " CNI 36" CNI Other2 7� I <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer >< Centrifugal pump <br /> Sampled with Disposable bailer:--X-1.- Teflon bailer <br /> Well Diameter: 2" /\ 411 6" 8 „ <br /> • Purge Vol Multiplier: 0 16 0 . 65 1 . 47 2 61 gal/ ft <br /> Initial Measurementech a easurement <br /> Time 2 - / Q Time: Calculated purge <br /> Depth of well . Depth to water: 4Kr 17 O Actual purge �— <br /> Depth to water : ;? <br /> Start purge . . 10 Sampling time; <br /> Time Temp. E. C. pH Turbidity Volume <br /> r1 � 2 -3 S-5, / .S� <br /> �67 833 7 - y/ <br /> ' <br /> 13 - 7 BZ 0 ?, 39 --- <br /> ' 7 3a <br /> Sample appearance: C�2�c. _ Lock: <br /> Equipment replaced : (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock #3753 : <br /> 4 " Locking Cap: Lock-Dolphin: 7/32 Allenhead: <br /> 6" Locking Cap: P 9/16 Bolt <br /> • Pinned Allenhead (DWP) <br /> Remarks <br /> Signature <br />