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DOITLOS ENVIRONMEN'T'AL COMPANY SAMPLING INFORMATION SHEET <br /> ' Client: <br /> Sampling Date: - [ ©� <br /> iSite • 6 / Project No. : <br /> /)- / D E S-ei,mL Well Designation: <br /> Is setup of traffic control devices required' YES time• hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut levels O If no, see remarks <br /> Is well cap sealed and locked' NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12 " DWP �r,� NI }� -- 36" CNI Other <br /> General condition of wellhead a sembly: Excellent oo Fair Poor <br /> Purging Equipment: 21" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer 7 , Centrifugal pump <br /> Sampled with : Disposable bailer: 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 Recharge e surement �� q <br /> Time: 7 c' . _ Time: /n 3 Calculated purge: 1 <br /> Depth of well - 6 S D Depth to water: Actual purge . <br /> Depth to water: <br /> Start purge: Sampling time: /D <br /> Time Temp. E. C. pH Turbidity Volume <br /> o . 3 6,g 7 <br /> 0. 2 <br /> (Dr 2 69 2 <br /> 10 ' r-- <br /> Sample appearance: M"1 Lock, AA, - <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 41' Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> . Remarks . <br /> Signature - <br />