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DOUL08 ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: 6 2- �- <br /> Site: Project No. q�i� k7�d! <br /> ,k0 - Well Designation: A W~3 <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 9 Y S 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 <br /> If no, see remarks <br /> Height of well casing riser (in inches) : _W <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK - <br /> 1210 BK 12" DWP 12" CNI 36" CNI _ therl2., <br /> General condition of wellhead assembly: Excellent oo Fair Poor° <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer' <br /> r 4" PVC bailer Centrifugal .pump <br /> 4 <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4"_X_ bn ger <br /> Purge Vol. Multiplier: 0.:16 0.65 1.47 2. 61_ gal/ft. <br /> Initial Measurement Recharge Measurement <br /> i Time: Qu� Time: 1X* Calculated purge: U <br /> Depth -of well: �1• Depth to water:7 . Actual purge: 3 <br /> Depth 'to water: 7 <br /> Start :purge: 415q Sampling, time: 533 <br /> Time Temp. E.C. pH Turbidity Volume <br /> !� �o 7 <br /> 51 <br /> Sample appearance: r 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 /> Remarks: <br /> signature: <br /> S <br />