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r <br /> DOULCB ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Project No. : <br /> Well Designation:-M vi/ - a <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? N 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: 811 W 1211 W 1211 EMCO 811 BK <br /> 1211 BK 1211 DWP 1210 CNI 3611 CNIthen <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2f1 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer centrifugal pump <br /> Sampled with: Disposable bailer• Teflon bailer: <br /> Well Diameter: 2111 411 611 Sol <br /> Purge Vol . Multiplier: 0, 16 0. 65 1 . 47 2 . 61 gal/ft . <br /> 1initial Measurement ReGharae Measurement <br /> Time : 5'1 Time: 12 ?� Calculated purge: 7 <br /> Depth of well : /4',5 Depth to water: Actual purge: P7� <br /> Depth to water: <br /> Start purge: 05f) Sampling time: /b 5 <br /> 1 <br /> Time Temp. E. C. pH Turbidity Volume <br /> 1 /05YG �' o IIZ171 - - _ <br /> 1 /05)- 16f, 9 I/�- 1 -702- �2, <br /> 1 <br /> 7d 57) 611 6f6 '20 2- 3 <br /> 1 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 21' Locking Cap: Lock #3753 : 7/32 Allenhead. <br /> 411 Locking Cap: Lock--Dolphin: 9/16 Bolt: <br /> M 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> I <br /> Signature: � ` <br />