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'DOTILOS ENVIROPU4EN1' L COMPANY SAMPLING INFORMATION SHEET <br /> Client:— .'"' ' Sampling Date: <br /> Site• ,:�- S q fi= �/'1/-� Proj ect No_ 9 L '6!9-C <br /> �1 <br /> Well Designation: jA1 VV- Z� <br /> Is setup 6fraffic- <br /> 'cZiGWf devices required? YES time: hours <br /> Is there' standing1 water in well�`'bIox? S Above TOC Below TOC <br /> •:�. .:r�..:. <br /> s top of cas inq ' NO If no see remarks <br /> Is well ca sealed:�'and locked? <br /> P _ NO If no, see remarks <br /> Height of welh'casifig......riser (.fin inches) : 2- <br /> Well cover type::..,:. 8". uv,.`�:'=�=.4't "12" W 12" EMCO 811 BK <br /> 12 BR ,- 12" DWP-' = 12" CNI 3611 CNI Other ,, <br /> General condition'of-"wellheadassembly: Excellent Good Fair Poor <br /> Pur "in ;.E. <br /> q g quipment. 72� disposable bailer Submersible pump <br /> 2n,PVC bailer Dedicated bailer <br /> 34-A11- PVC .bailer <br /> ; J�„Centrifugal pump <br /> • ' orf . ` .��-� := .>.. _ ,.•.-y. .,' <br /> Sampled' withi '` -Disposal bailer:_ Teflon bailer: <br /> `. ._ <br /> We11 Diameter:�x2 r: 411 611 811 <br /> Purge. Vol: Multzpllet: � 0 16" 0. 65 1.47 2 . 61 al ft. <br /> Initial Measurement Reclar a Measurement <br /> Time -til 14 :_... : Time:..: , r. : . ! <br /> r cam,,...;. Calculated purge: lir <br /> Depth of well::_6Q'�I�K : :::' Depth to water: S Actual purge: I,L L� <br /> Depth to water: ff ZL) <br /> Start purge:_ } Sampling time: <br /> Time Temp: ; E.C:" pH Turbidity Volume <br /> x. <br /> Sample appearance % Lock: <br /> Equipment replaced: (Check all that'-apply) Note condition of replaced item <br /> 2" Locking Cap: f_� ..:�:, '�`= Zock #3753 • 7/32/ Allenhead: <br /> 4" Locking Cap: ;_ r Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) <br /> :�� <br /> Remarks: r <br /> - .7 -r. a: ` -`.r � f'-';F"�yJ a".^4'j" f.'S'•�' .[5��.3't}, , h rrv: � k�✓. I <br /> i <br /> Signatur£s+,: <br /> z CR <br />