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w <br /> DOUL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> n <br /> Client: _ _ Sampling Date: "" 13 y71 <br /> Site: fi°2-6 ^_ Project No. : .6_26`d1 <br /> Designation: AN- <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? NOVDo If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 3 <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 3614 CNI Other_ rLW <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 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 /> AI'ime: L► _ Time: ��a Calculated purge: X6,7 <br /> Depth of well: Depth to water: Actual purge: 4C.7a:Lq <br /> Depth to water: <br /> Start purge:_- 4 sy _ Sampling time:X35 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 510 10, 1/a . 63 2 <br /> 5 J.5 ) 2. Jlo )� S/ <br /> Sample appearance: Lock: 3751 <br /> Equipment re laced: (Check all that apply) Note condition of replaced item __ <br /> 21t Locking Cap: Lock 13753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock--Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> 40 Remarks: <br /> Signature: <br />