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DOUL08 ENVIROMIENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: 't-G,+- �� � " jy�f~� o}✓f Project No. <br /> �fi}Lel- <br /> r., ." Well Designation: <br /> is setup of-.' traffic' control' devices _required? YES time: hours <br /> Is there standing water ani,we11 -'box? 'N YES Above TOC Below TOC <br /> . r <br /> Is top -of casing cut�.leve7'?' - . . - - NO iiit If no, see remarks <br /> Is well 'cap sealed and -locked? .4i NO E If no, see remarks <br /> Height of' well casing riser'•(in_, inches) : �. <br /> Well cover type: 8" W ' ` xr`12" W 12" EMCO 811 BK <br /> 12" BK - 12 n, DWP " 4 12"- ,CNI 3611 CNI Other <br /> General condition-'of wellhead assembly: Excellent Good Fair Poor 7, <br /> Purging Equipment:"% 21..1di6p6sable bailer Submersible pump <br /> 2! .PVC bailer Dedicated bailer <br /> .rry JL4 4" :PVC .bailer Centrifugal pump <br /> Sampled with Disposal bailer: Teflon bailer: <br /> Well Diameter:' 2" 4'r 6+' g+A <br /> Purge Vol.. Multiplier <br /> 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement ,: `..': --: R_echarQe Measurement <br /> Time: 3D1= _.;; -` Time:' ;' Calculated purge: <br /> Depth of- well:' Depth to water: Actual purge: <br /> Depth to water: : . <br /> Start purge: 1 = Sampling time: <br /> Time Temp.-; E.C..` : , pH Turbidity Volume <br /> _ r <br /> Sample appearance .,,. Lock: <br /> Equipment replaced::; (Check all 'that apply) Note condition of replaced item <br /> 2" Locking Cap:­-,­-,­-- "Lock` #3753: 7/32 Allenhead• <br /> 4" Locking Cap: bock-Dolphin: 9/16 Bolt: <br /> 6" LockingCap: <br /> Pinned Allenhead (DWP) <br /> Remarks: <br /> s4���}y"� ' <br /> •'��.3cY <br /> .._. ..•_ ,. a r Kala. z �� ' <br /> RvWf •riFj�w a���'r . <br /> Signature:: <br />