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DOUL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> 9 14 <br /> Client: �:«,cQ�.. Sampling Date: _ — 00 <br /> Site : l �6 / Pro3ect No. : <br /> P ,nL Well Designation: <br /> C <br /> Is setup of traffic control devices required YES time: hours <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut levell' NO if no, see remarks <br /> Is well cap sealed and locked' NO E if no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" W 12" EMCO 8" By <br /> 12 " SK 12" DWP 12" CNI 36" CNI Other) <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer: f P Teflon bailer: <br /> Well Diameter: 2"4 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 47 2 . 61 gal/ft <br /> Initial Measurement Rec ar a Measurement S- 3 <br /> Time. Time: z = 0.'L Calculated purge . <br /> Depth of well . �S Depth to water: a Actual purge <br /> Depth to water: 6 <br /> Start purge : `7 S Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> -7 r( zg � �� � .� <br /> -7 - o Is 2- <br /> -7 2 yo 7d � - <br /> Sample appearance : t'-, Lock: -b <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 /> J <br />