Laserfiche WebLink
rA0 <br /> DOUMOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> client: Sampling Date: <br /> r Site• 71144ee� Z44-0-12f- Project No. : <br /> n Well. Designation: IN <br /> 1 I <br /> r 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 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" UV12" EMCO 8" BK__ <br /> M 12 " BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent go Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> 1 Sampled with : Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 1.6 0. 65 1 . 47 2 . 61 gal/ft. <br /> 1 <br /> Initial easu Rec arae Measurement <br /> Time. q y Time:-_ `3 " , Calculated purge: <br /> Depth of well : / r r Depth to water: ' U Actual purge . <br /> Depth to water: <br /> Start purge: Sampling time: 3 = <br /> Time Temp., E.C. pH Turbidity Volume <br /> 70 7 - Sl -- t <br /> 3 : �r2 - 1 1 ( 00 �7 -'16 <br /> - - <br /> 71 60 - L-11198 7 - a <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> z " Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 4 " Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> • Remarks : <br /> 1 <br /> Signature : <br />