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DOOL08 BHVYRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:w_ rov'v' a 1 _ Sampling Date:, <br /> Site: c-a'L I> L Project No. : ``� �' - qt' j <br /> we6t "Well Designation: ` 3 <br /> Y <br /> • F <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? �j Above TOC Below TOC <br /> Is top of casing cut level? ENCS If no, see remarks <br /> Is well cap sealed and locked? N ES If no, see remarks <br /> Height of well casingrise (in inches) : <br /> Well cover type: 8" UV� 12" W � 12" EMCO 8" BK <br /> 12" BK 1211 DWP 12" CNI 3611 CNIer <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 211 disposable 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" 411 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2.61 gal/ft. <br /> 'tial MeasurAmwent Recharge Measurement <br /> ime: [ . _'Z_ _ Time: Calculated purge: <br /> epth of well: Depth to water: �� Actual purge: <br /> Depth to water: X4 <br /> Start purge: Z Sampling time: 3 , <br /> Time Temp. E.C. pH Turbidity Volume <br /> V3 -7 L 7 tD <br /> Z� 7A 7 -2- <br /> 13 7 <br /> 2-137 -23 7, 7 3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #3753: 7/32 Ailenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> .s Remarks: <br /> Signature: <br />