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^-� I r , .. ,w:,�v...i!Y,.lYq�lfWyll�.s11rQPNiS r117+Ku <br /> 1 <br /> DOULOB ENVXRONl{EMAL cONP�INY r r' SAMPLING INFORMATION SHEET <br />' '• Client: Sampling Date:� /� 0 �- <br /> Site ; r Project No. ; <br /> t <br /> Well Designation:je!_JMQ - <br /> 1 Is setup of traffic control devices required? time; hours <br /> Is there standing water in well box? No fydb Above TOC BeloW TOC <br /> Is top of casing out level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) ; <br /> Well cover type: 8" UV 12't UV12" ZMCO 8 " BK <br /> 1211 BK 12" DWP 12'f CNI 361, CNI they�� (PFFt <br /> em <br /> General condition of wellhead assbly: Excellent { Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 20' PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> 1 <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: �- Timei 4P Calculated purge: . <br /> Depth of well: Depth to water: Actual purge:]�:D <br /> Depth to water: <br />= start purge: 40 - clo Sampling time., <br /> 1 <br /> Time Temp.,. LF. C. pH Turbidity Volume <br /> �0.9 z 7 -29 1 7.aS <br /> a <br /> t <br /> Sample appearance: Lock: tAl <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 A21enhead (DWP) : <br /> Remarks : <br /> Signature : <br />