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.'DODL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> ` Client• <br /> Sampling Date• <br /> Site: 0 Project Na. -, <br /> /�A SV --Well Designation: :I..0! <br /> Is setup of• traffic`'controT`de_vices required? Y-ESN -_--time: hours <br /> Is there_ standing',,,-- ater' .iii'well box? . No YE 'Abov'e' TO Below TOC <br /> Is top of casing; cu `level. '" '= NO r -E I see remarks <br /> Is well cap' sealed` and 'locked? NO �t If na, see remarks <br /> Height of well casing riser =(jn in Well, cover: type:.. 8"f 12'r UV 1211 EMCD 8" BK <br /> 12" BK 12!! DWP`-r r .:._ 3219 CN-1 w' 36" CNI Other <br /> General condition-af-wel'lhea'dassembly: Excellent Good cFai� cPoo �'• <br /> Purging Equipment - 2_F-disposable bailer Submersible pump <br /> 2-'z! PLIC bailer Dedicated bailer <br /> ` 4 ' :?VC bailer Centrifugal pump <br /> Sampled with:`- Disposal{`bailer: )e <br /> Teflon bailer: <br /> Well Diameter: 2�� ' 4" 6+1 g++ <br /> Purge Vola Mul�lier:� 0. 65 1, 47 2 . 61 gal/ft. <br /> reme <br /> Initial Measunt w' {� '` Rachet a Measurement <br /> Time: ime;. 3�{,;. __ Calculated purge: <br /> Depth of well"::. ,, Depth' to water: �' .� _ Actual purge: <br /> Depth 'to water: <br /> •start purge: a R SamPlin time: <br /> „ . g <br /> Mime Tempi. E.C ' pH Turbidity Volume <br /> '73 931". <br /> I <br /> :mss. �, •.� _ - <br /> Sample appearance:' '' k ': Lock: <br /> Equipment-:replaced.," (Check all that apply) Note condition of replaced item <br /> 2" Locking, - =� ` ,y`,;` <br /> +, 'Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: - - bock Dolphin• - 9/16 Bolt: - <br /> 6" Locking Cap: 5-,-d <br /> Pinned Allenhead (DWP) <br /> Remarks <br /> .ya�J' tV �L <br /> WK <br /> t' Y <br />