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DOOLOS ENVII'ROO�N��MENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: ln� Sampling Date: <br /> t e <br /> Site : <br /> _ 6' _� - Project No. : <br /> S a. , <br /> L' P S- <br /> /.� / 0 E _l7cr/1nm�,p� r5eyrC, Well Designation: <br /> Is setup of traffic control devices required? NO YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TQC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? N If no, see remarks <br /> Height of well casing riser (in inches) ; <br /> Well cover type : 8" W 12" W 12" CO 8" BK <br /> 12 " BK 12" DWP .3-2-W-TNI "�e _ 36" CNI Other <br /> General condition of wellhead assembly: Excellent Good 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"_„Z:1- 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 . 47 2 61 gal/ft <br /> Initiaeasureme ech a Measurement <br /> Time . r �( Time : Calculated purge . IY :- <br /> Depth of well : ��• 0 Depth to water : Actual purge l^� <br /> Depth to water: <br /> Start purge. - 6 Sampling time: - 3� <br /> Time Temp. E. C. pH Turbidity Volume <br /> y r8 6'" 3 - -2 q <br /> 64 - 9 & <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 /> r <br />