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. DOQLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHE, <br /> Client:. OULY&-e�� _ Sampling Date: <br /> IS�gLl <br /> Site: 6U Project No- JLk -06-0/ <br /> Designation:. _ <br /> Is setup of traffic control devices required? YES e- hours <br /> Is there standing water in well box? 1"(jj a TO Below TOC <br /> Is top of casing cut level? NO <M if no, see remarks <br /> Is well cap sealed and locked? No If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV12" UV12" EMCO 8" BK <br /> 12" BK 12" DWP 1211 C:oj 36" CNI er /1' M�-,D <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 /> *Time: ( Time:_6 S 2 _ Calculated purge: �� <br /> Depth o f well: 6 I. l q Depth to water: Actua 1 purge: b,L � <br /> Depth to water: <br /> Start purge: 63 y Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 6 6g,1LZ <br /> 4, d 1 .1 z 1- 63 <br /> Sample appearance: Lock: 7`3 <br /> Equipment replaced: (Check all that 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 /> Signature: <br />