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DOQLOS ENVYRONKENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: r a rn n, r Sampling Date: <br /> i <br /> Site: Project No. : �� - b <br /> ti ,Well. Designation: �Q <br /> � adC <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? I? YES Above TOC Below TOC <br /> Is top of casing cut level? NO-MEW If no, see remarks <br /> Is well cap sealed and locked? N Y� If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8++ W 12" W 12++ EMCO g++ <br /> BK <br /> 12++ BK 12++ DWP 12" CNI 361+ CNI Other_ " D' Vz­ <br /> General condition of wellhead assembly: Excellent 2MFair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2++ PVC bailer Dedicated bailer <br /> 4" PVC baile�r/ _Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 21+ 4++--)—( 6+1 $++ <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2. 61 gal/ft. <br /> , Initial Measurement Rechar a Measurement <br /> Wme: "Z 3 Time: I Calculated purge: <br /> epth of well: &$ Depth to water: ��-� Actual purge: 3 9 <br /> Depth to water: 5 � <br /> Start purge: I Z r� `� Sampling time: I Z Z 3 <br /> Time Temp. E. C. pH Turbidity Volume <br /> Tt'D3 23, 7 7 _f S 7 hZ <br /> { Z ` ' 9 te aq �= Z <br /> ;i L, & � -715 <br /> 4- <br /> Sample` appearance: Lock: 7 -S-- <br /> Equipment replaced: <br /> '+ p (Checkallthat apply) Note condition of replaced item <br /> 2 Locking 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 /> r <br /> Signature: <br />