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I <br /> DOUL08 MMIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: �eoa,Sampling Date:_=,� 7 <br /> Site: t Project No. : <br /> I <br /> /64420 L e f tf a U QVe,. Well Designation: A'N <br /> G .9 <br /> 1 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? Wo 01M 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 " BK <br /> 12" BK 1.2" DWP 12" CNI 36" CNI Other M d C <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer IV Centrifugal pump <br /> r Sampled with: Disposable bailer:—Yl— Teflon bailer: <br /> Well Diameter: 24" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 . 61 gal/ft. <br /> ftnitial 11easurpEent RechArge ffgasurgagnt5, -7 <br /> ime: O Time: Calculated purge: <br /> Depth of well: 1 �' 3 S Depth to water: ' Actual purge:_,�T <br /> Depth to water:, -- <br /> Start purge: to Sampling time: .2 <br /> Time Temp. . E.C. pH Turbidity Volume <br /> 3y0 7 - 10 <br /> 1 <br /> -7• DI 3 <br /> 1 <br /> Sample appearance: e.• _ Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 1 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> i <br /> Signature: <br />