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« w....nr_ r— .+♦r .'ur!•R-M*.M�F~ci.v++rx.a .- .•n.rn w - <br /> _�_,.. .wr vrwwyW.�'•"L'NddflnwaG`�4�"1F' r!' n <br /> M <br /> DOUL0S ENVIRONXENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: , Sampling Date: <br /> Project No. ; <br /> 6 00 14!2LZg11_- Well Designation: M r <br /> n <br /> Is setup of traffic control devices required YES time: hours <br /> Is there standing water in well box? z4t� YES Above TOC Below TOC <br /> Is top of casing cut level? 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" UV12" EMCO Q" BK��[-- <br /> 1 12" BK 12" DWP 1211 CNI_ 36" CNI Other <br /> General condition of wellhead assembly: Excellent <1ffM_ Fair poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> 1 <br /> Sampled with: Disposable bailer:-4— Teflon bailer: <br /> Well Diameter: 2" ><- 4" 6" all <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft. <br /> 1 . R2=a a Measurement <br /> Time: Time: 1 2 '- 4 S Calculated purge: <br /> Depth of well , Z_ ULr Depth to water: Actual purge. •3 <br /> Depth to water: Q <br /> Start purge : f 7 Sampling time: 2 =� <br /> 1 <br /> Time Temp. _ E.C. pH Turbidity Volume <br /> �1 S 6I • q W 1/ 7 <br /> 1 <br /> 1t S 1 7G C3 7 . / y <br /> 1 z Vo _71. b S 2- 17 , /2 -�--- _3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock , 3753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> i 6" Locking Cap: Pinned Allenhead (DWP <br /> Remarks; <br /> f <br /> Signature : <br />