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'I ' ^-- .._... e , ' i . ,•„l..n,YtrYf+'rchyt{ }i1�SiS+51 s[vWfJ <br /> DOt7L08 ENVIRONMENTAL COMPANY - SAMPLING INFORMATION SHEET <br /> ,� <br /> Client: Sampl�.ng Date; Z' <br /> Site: r Project No, : <br /> 1 n Well Designation: - �d f x <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 cas If no, see remarks <br /> Is well cap sealed and locked? NQ S If no, see remarns <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8” UV12" UV12 ' EMCO 8" BK <br />' 12" BK 1211 DWP 12" CNY 36" CNI Other <br /> General condition of wellhead assembly: Excellent o"01Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> tri PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with: Disposable bailer:_,!?='- Teflon bailer: <br /> s Well Diameter: 2" �FL_ 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1. 47 2 , 61 gal/ft . <br /> • <br /> initial Measurement <br /> Time: :110 Time: Calculated purge: ` <br /> Depth of well : Depth to water: - Z T Actual purge : /o r <br /> Depth to water: <br /> ripT Start purge : Sampling time: I -3, tf of <br /> Time Temp... E. C. pH Turbidity Volume <br /> r <br /> Sample appearances Lock: <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 /> i 6" Locking Cap: Pinned Allenhead (DWP) : <br /> • Remarks: <br /> 1 _ <br /> Signature : ' <br />