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w D0ULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: 6- <br /> Site: <br /> -Site• Project No. : <br /> �61Well Designation; <br /> CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? Above TOC Below TOC <br /> Is top of casing cut level? NO (�,�--� If no, see remarks <br /> Is well cap sealed and locked? No� �J If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" LTV 12" W 12" EMCO B" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI other l OL- <br /> General <br /> LGeneral condition of wellhead assembly: Excellent = Fair Poor <br /> Purging Equipment: 2" disposable bailer _Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: 7 t9 Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol, Multiplier: 0, 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge _Mea_s_ur_e_ment <br /> Time: = 35 5, Time: 3 ; f `7 Calculated purge: <br /> Depth of well : Depth to water: 6 • f Actual purge: <br /> Depth to water: <br /> f <br /> Start purge: 3z 0 d Sampling time: 5- f <br /> Time Temp. E. C. pH Turbidity Volume <br /> , <br /> e-7 V ------ <br /> 3__1 L( 6.70 <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: 9/1.6 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks ; <br /> I <br /> Signature : <br /> I <br />