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1 <br /> DOUL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: Project No. : <br /> 1 <br /> ! n Well Designation: <br /> L K <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? CS 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 3 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV12" UV12" EMCO 8" BK <br /> 1211 BK 12" DWP 1211 CNI 36" CNI Other. 8 AGfO CS <br /> General condition of wellhead assembly: Excel 1 eTt___dn9b 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 Teflon bailer: <br /> Well Diameter: 2" � 411 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial e s e <br /> Time: Ar: Lr Time: Calculated purge: <br /> Depth of well: 19- 3 6 Depth to water: Actual purge. <br /> Depth to water: <br /> Start purge: q ! 3 Sampling time: 9 ' <br /> 1 <br /> Time Temp. .. E.C. pH Turbidity Volume <br /> qc3 4irY- [ <br /> � `3 6 6 �° a `� <br /> �1 �35 G 391 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWF) : <br /> Remarks: <br /> Signature: <br />