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10/01/1998 15 33 9167829054 DOUL05 <br /> PAGE 07 <br /> DQDLOS ENVIRONMENTAL COMpANy SAMPLING INFORMATION SHEET <br /> Client: Sampling Date.: <br /> Site: ri2f0itV Pro]aCt No. : <br /> Well Desi-gnation: <br /> o��fon . A <br /> IS setup of traffic control devices required? � YES time: hours <br /> Is there standing water in well box' S Above TOCBelow TOC <br /> Ia 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) . <br /> Well cover type: S„ W 12" W 12" EMCO 811 BK <br /> 12" SKS 12" DWP- 12" CNi 36" CNI ther <br /> General condition of wellhead assembly: Excellent oo Fair Poor <br /> Purging Equipment: 2„ disposable bailer Submersible pump <br /> G" PVC bailer Dedicated bailer <br /> 4" PVC bailer TCentrifugal pump <br /> Sampled with: Disposable bailer:_ Teflon bailer: _ <br /> Well Diameter: z"--V_ 4" Got gw <br /> ge Vol. Multiplier: 0. 16 0.65 1.47 2. 61 gal/ft. <br /> A J1 16, nt Recharge Measurement <br /> -Time: Time: 17 - Calculated purge:� <br /> Depth of well:_'76.151 Depth to water: a <br /> Depth to water: . $3 Actual purge: [ 3 <br /> start purge:--qO& Sampling time: <br /> Time Temp. E.C. PH Turbidity Volume <br /> Cos- -7/. I/ / kL - <br /> J.Lo 76 6 / � <br /> 7 �r <br /> 9/ 7a / 064 3 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Nate condition of replaced i <br /> 2p Looking Cap: Lock , 3753 : 7/32 Allenh ad; tem <br /> 4 Locking Cap:. :Lock-Dol hin <br /> 611 Locking Cap: p x/16 Holt: <br /> Pinned AllAnhoad (DWP) : <br /> . Remarks; <br /> Signature: <br />