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er, <br /> VP" <br /> t 1 <br /> DOULOB ENVIRONgENT'AL COQ PJWY SA"LING INFORMATION SHEET <br /> Client: Sampling Date,. ,/ <br /> 1� S i to :4&9=a. zi-act. Project No. ; <br /> I;E6 00 t 0J=1aQ ..Sga Well Designation: Al O/- <br /> t <br /> 1 Is setup of traffic control devices required? (�P YW time: hours <br /> Is there standing water in well box? NDAbove TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? N If no, see remarks <br /> Height of well casing rinser (in inches) ! <br /> Well cover type: 811 UV 12'1 W� 12" EMCO " 8K <br /> 12 " BK 121" DWP 1211 CNI- 36" CNI Other$ AlOY`re5 <br /> General condition of wellhead assembly; Excellent Good Fair Poor <br /> Purging Equipment: 2s1 disposable bailer submersible pump <br /> 21' PVC bailer Dedicated bailer <br /> 41' PVC bailer Centrifugal pump <br /> Sampled with; Disposable bailer: <br /> P p Teflon bailer: <br /> Well Diameter: 2"X_ 4 s 6" 811 <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1, 47 2 . 61 ft. <br /> Initial gal <br /> • / <br /> Time : F O Time: - Calculated purge: <br /> ©.O <br /> Depth of well; Depth to water: Actual purge: - <br /> Depth to water: <br /> start purge : Z-�� sampling time: zzSR <br /> i <br /> Time Temp.; . 3,C. pH Turbidity Volume <br /> �Z,5/ 26 -' 5(2- ass' / <br /> Sample appearance: Lock: It /A <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 /> • Remarks : <br /> Signature : <br />