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10/@1/1998 15 33 9167829054 <br /> ID©ULOS PAGE 03 <br /> DODLOS ENVxRONMFN'X'AI, COMpANy SAMPLING INFORMATION SHEET <br /> Client: A f Sampling Date: -� <br /> Site: <br /> project No. : <br /> - UA I Well. Designation: ~ r <br /> Is setup of traffic control devices required? YES time: hours B <br /> Is there standing water in well box? YES Above TOC 810W TOC <br /> Is top of casing cut level? YXS If no, see remarks <br /> Is well cap sealed and locked? N ES If no, see remarks <br /> Height Of Well casing riser (in inches) : <br /> Well cover type: 8'l uv 12" W 12" EMCo�i 8" B �_ <br /> 12" BK 12" DWP fir' CNI 36r' CNI <br /> General condition of wellhead assembly: Excellent Goodherai Poor <br /> Purging Equipment: 2" disposable bailer <br /> Submersible pump <br /> 2rr PVC bailer Dedicated bailer <br /> 4" PVC bailer Dedicated <br /> pump <br /> Sampled with: Disposable bailer: <br /> Teflon bailer. <br /> Well Diameter: 2" 4" 6" all <br /> Purge vol. Multiplier: 0.16 0. 65 1.47 2.61 gal/ft. <br /> Measurement Rechar e t <br /> ime• Time; •i Calculated purge: 7/ <br /> D4pth of well: 1, X1 Depth to waters Actual purge:� <br /> Depth to water: <br /> Start purge: `�f Sampling time: 10 1 <br /> Time Temp. E.G. E75K <br /> Turbidity Volume <br /> Vs 72 L Du al <br /> ff loot 7z, z 1 u�.1, 0 3 <br /> Sampleappearance; <br /> p 441.,.. Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2 Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin:_ _ <br /> 6" Locking Cap:—�� 9/16 Bolt:i�� <br /> ----�----- Pinned Allenhead (Dwp) <br /> Remarks: <br /> Signature: <br />