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DOUL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date:, �19-� <br /> Site Project No. : <br /> S&vr►.L Well Designation: Al 64,/ <br /> i <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) : <br /> Well cover type: 8" UV12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other I � 1 <br /> General condition of wellhead assembly: Excellent �to 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" 4" 6" 8" <br /> Purge Vol . Multiplier: 0. 16 0 . 65 1. 47 2 . 61 gal/ft. <br /> initia-l-Measuremen Recharge Measurement <br /> Time : 19,- ' 3.6 Time: calculated purge: 7. <br /> Depth of well • Sof �� Depth to water: - 60 Actual purge 7- <br /> Depth to water: <br /> Start purge: Sampling time: • � <br /> Time Temp. E. C. pH Turbidity Volume <br /> = 4 �' • 0 70 7 • t 2 ---� <br /> _-L-0 <br /> Sample <br /> Sample appearance: Lock: AV <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: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature: <br />