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,1 T y.._� I , r j . h^IS,WYi1U'[.hWIQfLR�1�iN�1.�f11;."11 <br /> Jl <br /> I <br /> DOU108 ENVIRONXENTAL COMPANY SAMPLING INFORMATION SHEET <br /> i <br /> Client : Sampling Date; ' %� - <br />► Site: Project No. ; <br /> I n Well Designation: /61' U�/ ` Z <br /> _ <br /> Z- <br /> Is setup of traffic control devices required? <fTP YES time: hours <br /> Is there standing water in well box? tSP 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 remar� s <br /> Height of well casing riser (in inches) ; <br /> Well cover type: 8" UV 1211 UV12" EMCO 8" BK <br /> 12" BK 12" DWP 1.2" CNI 36" CNI Othe a I1 `- <br /> General condition of wellhead assembly: Excellent o c Fair Poor <br /> Purging Equipment; 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer 3=centrifugal pump <br /> Sampled with: Disposable bailer:- Teflon bailer: <br /> E <br /> t Well Diameter: 2" 4" 6" 8" <br /> purge Vol . Multiplier; 0 , 16 0, 65 1, 47 2 . 61 gal/ft , <br /> Initial MeasurementMemsmrenellt <br /> Time : /0.•3 0 Calculated purge . <br /> Depth of well; 2 Depth to water: Actual purge - 6 - (2 _ <br /> Depth to water: 2 <br /> rig Start purge ,-/ 2-15'0 Sampling time; � <br /> Time Temp.... E. C. pH Turbidity Volu*Me <br /> i <br /> Sample appearance : Lock; / 41 <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap; Lock J3753 ; 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap; Pinned Allenhead (DWP) : <br /> Remarks ; <br /> Signature : ' <br />