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» .. ,3 _' . s..rrarNn.irq�IlB.rt'�1yyi!•f,krJ <br /> Is <br /> DOULOB ENVIROMENTAL COMPANY - SAMPLING INFORMATION SHEET <br /> Client: r , Sampling Date: <br /> Site: Project No. ; <br /> / DD PQh-&,1 Ao' Well Designation: /vl IA-,"' <br /> Ld 4� <br /> tt <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? O If no, see remarks <br /> Is well cap sealed and locked? NO� If no, see remarks <br /> Freight of well casing riser (in inches) : <br /> Well cover type; 811 UV_ 12 11 W 1211 EMCO 8" BK <br /> 1211 BK 1211 DWP 1211 CNI_ 3 611 CNI Other /20 <br /> 1 General condition of wellhead assembly: Excellent cmFair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> 1 Sampled with: Disposable bailer:_ Teflon bailer: <br /> Well Diameter: 211 411 611 811 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal ft. <br /> Initial Measurement �''� /'` <br /> 1 . Time. R <br /> Timer. Calculated purge: <br /> Depth of well : /9 Depth to water: d Actual purge:--- <br /> Depth to water; <br />'1 Start purge: 10 Sampling time: <br /> S <br /> 1 Time Temp... E.C. pH Turbidity Volume <br /> : 17 79 <br /> 0 25 - a <br /> 1 Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #37531 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> 1 <br /> Remarks; <br /> 1 Signature: <br />