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t <br /> 1 <br /> DOUL08 ENVIROMNTA.L COMPANY - SAMPLING INFORMATION SHEET <br /> vl r <br /> Client: /rO, Sampling Date: <br /> • Site: Project No. : <br /> 1 <br /> / 6 0o sCak-/un Ro� Well Designation:-_N1 W O <br /> Z_ A 11 <br /> Is setup of traffic control devices required? &V YES time: hours <br /> 1 Is there standing water in well box? N Y AboveTOC 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 /> Height of well casing riser (in inches) : 3 <br /> Well cover type: 81' UV 1211 W 12" EMCO 8" By <br /> 12" BK 12" DWP 12" CNT 36" CNI CLther MOP- l <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer centrifugal pump <br /> 1 Sampled with: Disposable bailer: � Teflon bailer: <br /> Well Diameter: 2" 411611 8" <br /> Purge Vol . Multiplier: 0. 16 0. 65 1.. 47 2 . 61 gal/ft. <br /> Measurement*Initial <br /> Time: Time: D�. Calculated purger <br /> Depth of well, Depth to water. Actual purge: <br /> Depth to water: <br /> �k, LIM <br /> Start purge: a ' 10 Sampling time: 14 <br /> Time Temp... E.C. pH Turbidity Volume <br /> to ; It ­7 3 -? 3© 6 7 -/ e <br /> o = I -7 ? -6 C-) ? o y 2 <br />' I03 -73 '2- 1S -7 �- 3 <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 /> 1 <br /> iRemarks: <br /> Signature: <br />