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r <br /> DOUL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: 10-114 -11y <br /> Site: ,Sens &, 66-6 Project No. : g4 -696-01_ <br /> 1444 W f__ Well Designation:_ <br /> Is setup of traffic control devices required? Q§ YES time: hours <br /> Is there standing water in well box? 10 Y S Above TOC Below TOC <br /> Is top of casing cut level? NO gtP If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : 1/4 <br /> Well cover type: 8" UV12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other Ir" <br /> General condition of wellhead assembly: Excellent Good Fair P or <br /> Purging Equipment: X311 disposableo bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: -SOR C 15'?• 2§) Time: LID? Calculated purge: U a <br /> Depth of well: J7,2,Z Depth to water: _SS 90 Actual purge:-1} <br /> Depth to water: JJb <br /> Start purge: Sampling time: 410 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 43 Z02-1 > 1 <br /> X47 <br /> 356 -71, q <br /> Sample appearance: _rA ,,,, Lock: <br /> Equipment replaced:- (Check all that apply) Note condition of replaced item <br /> 2" Lacking 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 /> Signature: <br />