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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> OEM <br /> Client 1421"f <br /> Sampling Date: 6`.12 -00 <br /> Site _ z Project No <br /> - Well Designation MW- <br /> 17 <br /> Is setup of traffic control devices required" O YES time hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut levels N If no, see remarks <br /> Is well cap sealed and locked> NO Y S If no, see remarks <br /> Height of well casing riser (in inches) e <br /> Well cover type, 8" W 12" UV _ 12" EMCO 8"' BK <br /> 1211 BK 1211 DWP— - 1211 CNI 3611 CNT <br /> General condition of wellhead assembly: Excellent 00FairPoor <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• 211 4 11 611 811 <br /> Purge Vol Multiplier, 0 . 16 0 . 65 1 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar e Measurement <br /> Time !// Time, 12 Calculated purge <br /> Depth of well . <br /> .x. Depth to water: - <br /> _gyp_E[LE Actual purge <br /> - <br /> Startto water. <br /> Start purge. 15 Sampling time: L <br /> Time Temp E C. pH Turbidity Volume <br /> I a6, <br /> Sample appearance - Lock. <br /> Equipment replaced. (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap. Lock x`3753 • <br /> 4 "" Locking Ca 7/32 Allenhead- <br /> �� g P• Lock-Dolphin: 9/16 Bolt* <br /> 6 Locking Cap: Pinned Allenhead (DWP) • <br /> Remarks : <br /> NOW <br /> Signature - <br />