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f _`S�a`✓f is`N'YM°�"r w 1 �C+fM • f <br /> i .»YfYCy.v4.�fr�ISIl�V1i ?SMj"+r1`'/t' <br /> DOUL08 ENVIRONS MAL COXPANY SAMPLING INFORMATION SHEET <br /> • Client: Sampling Date: /2Z- <br /> R S i t o 7-1 'z4-'4Project No. : <br /> POb-IGlnWell Designation: ' 7 <br /> 1 Is setup of traffic control devices required? Y S time: hours <br /> Is there standing water in well box? NO Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NIf no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 1 1211 5K 12" DWP 1211 CNI 36" CHI A=her <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer .� Centrifugal pump <br /> 1 <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> • Purge Vol . Mu iplier: 0. 16 0, 65 1. 47 2 . 61 gal/ft. <br /> Initial 1 r � <br /> Time: IQ :O Time: .! Calculated purge:_ <br /> Depth of wel 2 0,/Y Depth to water: Actual purge: fL <br /> Depth to water: <br /> Start purge: .O ri Sampling time:--/ 7S ! -0"5"- <br /> Time <br /> S = /STime Temp. .. E.C. pH Turbidity Volume <br /> z-z G �_$ro ,fig 1 <br /> s:04K2 z . G I A �' 2 <br /> I <br /> Sample appearances - Lock: <br /> Equipment replaced: (CFifegk al� that appxy) placed item <br /> Note'dlccondit*�.-on of re <br /> 211 Locking Cap: '` Loc #,F3753 : `'` 7� Allenhead: <br /> " <br /> 4Locking Cap: Lock-Do �in:. t M'9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP <br /> Remarks: <br /> t <br /> Signature : <br />