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DOVLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: qi(.&,� Sampling Date:-, <br /> Sited Project No. : 3'0i <br /> goo S, c Well Designation: mW-2a <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Y 3 Above TOC Below TOC <br /> Is top of casing cut level? N S If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : I _�5 . ­ <br /> Well <br /> cover type: 8" W 1214 W 1211 EMCO 811 BK <br /> 12" BK 1211 DWP 1290 CNI3611 CNI her <br /> General condition of wellhead assemb y: Excellent Goo Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer: _ Teflon bailer: <br /> Well Diameter: 211 4" 6" 80° <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 2 .61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: /1 '/ 1 Time: Calculated purge: 0344d <br /> Depth of well: 7ZI-?* Depth to water:^ Actual purge: a� <br /> Depth to dater: go:.Lt <br /> Start purge: I1;40 Sampling time: 535 <br /> Time Temp. E.C. pH Turbidity Volume <br /> La.t� C_ <br /> s. 11 3 <br /> 7o. 1 m <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: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: � •- _ __ <br />