Laserfiche WebLink
DOULOS ENV <br /> �I <br /> /RONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: . [ �� Sampling Date: 3 �« —0 <br /> Site: 601 Project No. : <br /> m , Well Designation:_ w � <br /> . `.tt f G 79 <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? If no, see remarks <br /> Is well cap sealed and locked? NOIf no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 1.2" W 12" EMCO 8" K <br /> 12" BK 12" DWP 12" CNI 36" CNI Other ( 2- 4/' C_� <br /> General condition of wellhead assembly: Excellent921 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:_2�_ _ Teflon bailer: <br /> Well Diameter: 2" 4" 6" 811 <br /> Purge Vol . Multiplier: 0. 16 0 . 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement Recharae Measurement <br /> Time. 0 Time: U 9,,,,)Calculated purge: <br /> Depth of well : `71 4 Depth to water; f CU Actual purge; <br /> Depth to water: <br /> Start purge: 3 Sampling time: y <br /> Time Temp. E.C. pH Turbidity Volume <br /> 6q q <br /> L- go 10 . 6 - ,30 <br /> Sample appearance: ct. / Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />