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T ,4 <br /> 5 <br /> DOUL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> i, <br /> . Client: Sampling Date:/ 2-/010'2-- <br /> S i t e:4A2& , c.� �1_���{� Project No. : <br /> / 3'600 S. 142J=14, Ral <br /> Well Designation: <br /> LA <br /> 4 <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? S Above TOC Bel0V TOC <br /> Is top of casing cut level? 0 If no, see remarks <br /> Is well cap sealed and locked? No S If no, see remarks <br /> Height of well casing riser (in inches) ': 2. <br /> Well cover type: 8" UV 12" W 12" EMCO 8" BK <br /> 1 <br /> 1211 BK 1.2" DWP 1211 CNI_3 6" CNItherQ'r(^a�T(S <br /> General condition of wellhead assembly: Excellent Air Poor <br /> Purging Equipment: 2+1 dispos4ble bailer Submersible pump <br /> 21' PVC bailer Dedicated bailer <br /> 1 4" PVC bailercentrifugal pump <br /> Sampled with: Disposable bailer: � Teflon bailer; <br /> Well Diameter: 2; 4" 6" 8" <br /> • Purge Vol . Multiplier: 0. 16 0, 65 1.47 2 . 61 , gal/ft . <br /> 1 <br /> Time; Time: = Calculated purge: � y� <br /> Depth of well : ZD-! Depth to water: -2 / Actual purge : <br /> Depth to water: <br /> start purge : l ? {l0 Sampling time: <br /> I ' <br /> Time/ Temp., E. C. �] pH Turbidity Volume <br /> z : r3 2 -z, <br /> w <br /> Sample appearances Lock: h <br /> Equipment replaced: (Check all that apply) Note ,condition of replaced item <br /> 211 Locking Cap: Lock #37531 7/32 All.enhead; <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP <br /> Remarks ; <br /> Signature <br />