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DOUL08 ENV <br /> I <br /> RO <br /> NMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site Proaect No. <br /> Well Designation: w S <br /> Is setup of traff is control devices required7 AT9 YES time : hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level's NO If no, see remarks <br /> Is well, cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser ( in inches) : _f�L44 <br /> 5 <br /> well cover type : s" W 12" W 12" EMCO 8" BK <br /> 1211 BK 1211 DWP IV�WNI� 36-1 CNI Other <br /> General condition of wellhead assembly: Excellentoa 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: Teflon bailer: <br /> Well Diameter: 2" 411 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 . 61 gal/ft <br /> Initial easureme t Recharge Measurenent 2 <br /> Time. Time: r Calculated purge: <br /> Depth of well . / -3 - 0 / Depth to water: Actual purge7- <br /> Depth to water . <br /> Start purge : 3d Sampling time: r4 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 3,36 66 <br /> 3 = o 0� 7- 2 ao -7 - q3 - 3 <br /> -S <br /> Sample appearance: Lock- <br /> Equipment <br /> ock•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 /> r <br />