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1 <br /> DOVLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> . Client: Sampling Date: <br /> Site: Project No. : <br /> n Well Designation:__`-� <br /> CIA <br /> Is setup of traffic control devices required? O YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? NO TksIf no, see remarks <br /> Is well cap sealed and locked? No 4 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12 if W 1211 EMCO 8" BK <br /> 121' BK 12" DWP 12" CNI 36" CNI ther <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailerCentrifugal pump <br />► Sampled with: Disposable bailer:—A- Teflon bailer: <br /> Well Diameter: 211-1— 411 611 811 <br /> Purge Vol , Multiplier: 0. 16 0. 65 1 . 47 2 . 61 gal/ft <br />► Initial e su aMeasurement <br /> L 3 <br /> Time : Time:. /D DCalculated purge: <br /> Depth of well; ! Depth to water: _%,3� Actual purge : 5.J i) <br /> Depth to water: 101- <br /> Start <br /> OLStart purge: l D� a Sampling time: 100'? <br /> i <br /> Time Temp. E.C. pH Turbidity Volume <br /> Ivo ( 641 1 /)-/0 71 �---�� <br />` oo61,0 9 61 71,r 2 <br /> Io03 611 73 71 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 /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt : <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />