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T - - <br /> 'DOUI,pg ENVIRONM33NTAL caxpANy. SAMPLING INFORMATION SHEET <br />`f <br /> Client. - - .- - Sampling Date: <br /> Site: ' 14 Project No. J;i- -'] <br /> Well Designation: L,i , <br /> .. ,_-,_n.:'4..;'j_..�.�"`r'e;;•yiA?4'�x-�r'�o-w:'.�a•�rr���_',c; <br /> Is setup of traffic-control_ devices required? O YES timer hours <br /> Is there standing,water.in.,,weLl ,box? NO Above TOC Below TOC <br /> Is top"of casing_ cutx 1'evel? .a :- '`= NO If no, see remarks <br /> Is well cap. sealed and. -locked?": NO YES If no, see remarks <br /> Height- of well ' casing riser.; --( n inches) : <br /> Well, cover, type:,-'. g'! UV:? t ':'^r.. 12".' UV 12" EMCO <br /> �r <br /> 7 <br /> 12'x:. BK12" DWP � : .- 12 ;CNI '=- 3 6" CNI Other /,- <br /> BK <br /> - :. <br /> General condition'Tof- wellheadassembly: Excellent G�i Fair Poor ' <br /> Purging Equipment,:-'-,F 2disposable bailer Submersible pump <br /> _2".PVC bailer Dedicated bailer <br /> s r 4'" 'PVC bailer <br /> N,. --X Centrifugal pump <br /> Sampled with:. Disposal bailer:_ <br /> Teflon bailer: <br /> e=,77, <br /> Well Diameter­ 2" 4» 6,1 $11 <br /> Purge, Vol.- Multiplier: ` 0.15 0. 65 1. 47 2 . 61 <br /> Initial Measurement; ",::� -`- ' ; gal/ft. <br /> Time• '� �.-. -tim- Recharge a Measurement <br /> .F.r Calculated purge: ---/ <br /> Depth' of well: to water: !�,6? <br /> Depth to water: Actual purge• <br /> Start purge: F1 'Sy • y°' '- Sampling time: 7 <br /> Time pH Turbidity <br /> Volume <br /> . �.y ./ , •''? cmc�, � IIT"f <br /> v -� <br /> Sample appearances <br /> Lock: <br /> Equipment replaced:• (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: `� F Y ;4' -9Lock .,j3753 : <br /> --'—� � 7/32 Allenhead: <br /> 4" Locking Cap: - <br /> Lock Dolphin:-- <br /> 5" Locking Cap: - � 9/16 Bolt:_ <br /> • _= Pinned Allenhead (DWP) : <br /> Remarks: 0&Y <br /> [, 777, <br /> :.1..- <br />