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DOULOB ENVIRONKENTAL L-OMPANy SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> site: 6`°Z 7yV Project No. : I L4- 1� -07 <br /> mammon Well Designation: AA W1J,k <br /> - IS setup of t ;.M`«n_ <br /> raffic ,controf devices .required? YES time: hours <br /> Is there standing water` in'`we.M', box? Y S Above TOC Below TOC <br /> ;., <br /> Is top of casing' cutlevel'? s=:-;'. NO E If no, see remarks <br /> Is well ca sealed and ''locked?.'-° <br /> p - _, _ NO XE If no see remarks <br /> Height of' well casing`_riser",.'(in' inches) : Z <br /> Well' cover type ' 8 I W"" _0. =.,;__�: . 12" UV 12" EMCO 8" BK <br /> 1211 BK , 12'! DWP .. .. „_.. <br /> ---- L:-CNI 36" CNI Other <br /> General 'condition' of'wellhead "'assembly: Excellent Good Fair Poor <br /> Purging Equipment. 2", disposable bailer Submersible pump <br /> rr < 2!!, PVC :bailer Dedicated bailer <br /> 4' PVC bailer rife <br /> Cent gal pump <br /> Sampled with::, Disposal"bailer: Teflon bailer: <br /> Well Diameter.:- <br /> 2 ` 411 (, w 611 Su <br /> Purge Vol. Multiplier 4. 65 1.47_ 2 . 61 gal/ft. <br /> Initial Measurement "= "'1- `'; Recharge Measurement <br /> Time: r .Time: Calculated purge: <br /> Depth of well: " ^ Depth"to:water: <br /> Depth to water: <br /> Actual purge: <br /> Start purge: - 5 -Sampling time: <br /> TimeTemp. C:* pH Turbidity <br /> Volume <br /> Sample" appearance: f: =- `" Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap:"--." 'Lock x$`3753 <br /> 4 Locking Cap. 7/32 Allenhead. <br /> ,r LockMDolphin• 9/16 Bolt: � <br /> 6" Locking Cap: Pinned Allenhead (DWP) :_ <br /> x_.... <br /> Remarks: <br /> %Y <br /> MWIV .F. <br /> .,1 _ f ."':.' r�.•+Vif ` Y$ ~I�i tea, 5�' .. . <br /> Signature;' <br />