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DOUL08 END'IRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> . Client: Sampling Date: <br /> SitePro3ect No <br /> _ a�nrrn-per r33umt Well Designation : vLy(/� <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's NO E If no, see remarks <br /> Is well cap sealed and locked" _oi E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type : 8" W 12" UV 12" EMCO 8" BK <br /> 12 " BK 1211 DWP NI_ 'L 3611 CNI other <br /> General condition of wellhead a sembly: 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: Teflon bailer <br /> Well Diameter: 2"-Zl- 4" 6" 8" <br /> Purge Vol Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal/ft <br /> rr � t al Measurement Recharge -Measurement <br /> Time _ -_ O Time : - 3 Calculated purge <br /> Depth of well Depth to water: �f �o Actual purgez <br /> Depth to water • HY Z3 <br /> Start purge _ r Li Sampling time : <br /> Time Temp. E. C. pH Turbidity Volume <br /> /o o <br /> Sample appearance: Lock - <br /> Equipment replaced. (Check all that apply) Note condition of replaced iter <br /> 2 " Locking Cap: Lock x`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 />