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1 <br /> DOUL08 ENVIrROMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: 011- r <br /> site:4f329.1 <br /> Project No. : <br /> /3'6 00 4, LQJ Gin Ro� Well Designation: �"� - 6 <br /> L 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 <1W If no, see remarks <br /> Height of well casing riser (in inches) : Lt ,x <br /> Well cover type: 8" UV 12" UV1211 EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> 1 General condition of wellhead assembly: Excellent e-6-63'8'i 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:-i Teflon bailer: <br /> Well Diameter: 2" � 4" 6" 8" <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft <br /> initial tleasurement RecharaQ Ifeasurement <br /> Time: - / 7 Time; lip = 10 Calculated purge: 5• <br /> Depth of well: .2O • 0 �7� Depth to water: - 3 Actual purge: 5 . <br /> Depth to water: 8 - 7 <br /> Start purge: f0 0ep sampling time: /O= r <br /> Time Temp. , E.C. pH Turbidity Volume <br /> � 0 ' 0I d3 - q "? `7 - I <br /> -10 '03 G / g '� 6) 1 7 . 3 o 2- <br /> 1/0 ray - 0 -7 - 1- 5 3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> . Remarks: <br /> Signature; <br />