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1 hlf <br /> DOOLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: Project No. : <br /> r6� Well Designation: !N) w r <br /> Is setup of traffic control devices re <br /> Is there standing water in well box? qu�.red. YES time: hours <br /> Is top of casing cut level? YES Above TOG Below TOC <br /> Is well. cap sealed and locked? NO If no, see remarks <br /> } NOq E If no, see remarks <br /> Height of well casing riser (in inches) : _ _ <br /> Well cover type: 8" UV 12" UV 12" EMCO - 8�� BK <br /> -- <br /> 1211 BK 12" DWP 12'{ CNI� 3611 CNIOther <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2" disposable bailer _K Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal. pump <br /> Sampled with: Disposable bailer: SP Teflon bailer: <br /> ' Well Diameter: 2" 4n 611 grr <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft <br /> Initial Measurement Recharge Me surement <br /> - Time., Calculated purge: S� <br /> Depth of we 1 Depth to watActual purge: <br /> Depth to water: Y <br /> { Start purge: 1 / 0 <br /> d Sampling time: / 2-Z <br /> Time Temp. E. C. pH Turbidity Volume <br /> ! oG ��' 3 f21y 716 <br /> 1 12 <br /> 02 7 o el �--- 3 <br /> Sample appearance: � � Lock: !M S <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock , 3753 • <br /> 411 Locking Cap: Lock-Dolphin: 7/32 Allenhead:_ <br /> 6 Locking Cap: 9/16 Bolt: <br /> Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature : <br />