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DOULOg ENVIROMMEMTAL COMPANY SAMPLING INFORMATION SHEET r <br /> Client: Sampling Date,- <br /> Site: Project No. <br /> `s'✓� ' ► Well Designation: <br /> Is setup of traffic 3�contr 1 dices' required? YES time: hours <br /> Is there standing 'water:in"'r4ii l ;box? o YES Above TOC Below TOC <br /> Is top of casing cutlevel � 4 NO E If no, see remarks <br /> Is well 'cap sealed and 'locked?, <br /> " <br /> NO If no, see remarks <br /> Height of' well casing .riser '(;ins inches) : _ <br /> Well cover type:- an UV - '« x`12"_ UV3-211 EMCO 8 of BK <br /> 12" BKS 12'! DWP ''" .CNI 36" CNI Otherl.,�- <br /> General- cvnditiofi`"of -wel•lhead�'assembly: Excellent Good Fair Poor <br /> '�'` x <br /> Purging Equipment: Y211 disposable bailer Submersible pump <br /> 2"`:PVC bailer Dedicated bailer <br /> z= _4" PVC wailer �Centrifugal pump <br /> Sampled with:` Disposal 'bailer: Teflon bailer: <br /> Well Di . er._ 2n .r 4, <br /> �, 6+1 8+1 <br /> amete <br /> Purge Vol. Multiplier•, .; 0�;16`:'''�4�-S.,;.`: 0.6� 1.47 <br /> 2 . 61. gal/ft. <br /> Initial Measurement-. Recharge Measurement <br /> Time: o =' Tlmel. Calculated purge: <br /> k <br /> Depth of well _[�q,3D Depth to„water: Actual purge: <br /> Depth to water: <br />• Start purge: <br /> e: <br /> P g Sampling time: <br /> Time Temp - E.C."'; pH Turbidity Volume <br /> I <br /> - .. o ... -•'sem".y:.,,'• <br /> _ I <br /> - I <br /> Sample appearance: - �e ry Lock• <br /> Equipment replaced:.-, (Check al1`t, hat aPP y) Nate condition of replaced item <br /> 2” Locking Cap*.'-,%,. `r:. .�� v "_ sock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: =Y_,-_. - Loc "Dolphin: 9/15 Bolt: <br /> 61' Locking Cap: Pinned Allenhead (DWP) <br /> Remarks• ` <br /> „J n- <br /> :-0 s _ - s vF �r ati.,..�.}} -nn�Pj+[r • -'+'ray,y-.w--_ <br /> ass sC c <br /> Sa at t . <br />