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I <br /> DOVLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> oes u-c�c,.,C� 3 <br /> site: Project No. : <br /> . Goo Hr.rlo Pd <br /> - Zia ail Well Designation; <br /> roe CA 0 <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 if no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12 It UV_�, 12" EMCO 8" BK�� <br /> 12" BK 12" DWP 12" CNI 36" CNZ Other <br /> General condition of wellhead assembly: Excellent d� FairPoor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> F Sampled with: Disposable bailer:_ Teflon bailer: <br /> Well Diameter: 211,4„ 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> e s <br /> s <br /> I : Calculated purge: <br /> Depth of well: - 7 _{ Depth to water: Actual purge: S <br /> Depth to water: <br /> Start purge:p g _j_2 5 Sampling time: s3 <br /> 1 <br /> Time Temp. E. C. pH Turbidity Volume <br /> [ • Ll 7 1 L •3 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 /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> 1 <br /> Signature: <br />