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DOQLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: fi Project No. : 9 L4 — �l 3 f <br /> �. +Of wit- n L41 Well Designation:COL <br /> W <br /> �--�1 <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? 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), : 2. <br /> Well cover type: 8" W 12" UV. 12" EMCO 811 BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4" X 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> `ime: `. Time: 3 Calculated purge: 3 7� r <br /> depth of well: Depth to water: 6 3 Actual purge: _ <br /> Depth to water• <br /> Start purge: 3 OSampling time: 3 3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> z:, 2 `77 3 -7 L'3 3 <br /> Sample appearance: Lock: �►,� <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753: 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> L... <br /> Remarks: <br /> Signature: <br />