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DODLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Sampling Date: /1- <br /> Site: <br /> 1-Site: AeACleh Project No. : <br /> Well Designation: <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? - O fn If no, see remarks <br /> Is well cap sealed and locked? NO io If no, see remarks <br /> Height of well casing riser (in inches /1-- <br /> Well cover type: 8" UV12" LTV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI -Other <br /> General condition of wellhead assembly: Excellent E00)11 Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer )4 Centrifugal pump <br /> Sampled with: Disposable bailer:,,_ Teflon bailer: <br /> Well Diameter: 200_/� 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 7j0 _ Time: q/O Calculated purge: <br /> Depth of well: Depth to water: Ok Actual purge: <br /> Depth to water: �• - _ <br /> Start purge: Cf?( Sampling time: q/i <br /> Time Temp. E.C. pH Turbidity Volume <br /> 7-0 ,L 7.32 <br /> 1453 <br /> 1b� 6f 721 3 <br /> 673 717 4 <br /> Sample appearance: Lock: 375.E <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 /> Signature: , , , U <br /> U JL4 <br /> U <br />