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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client- Sampling Date: 6-J1.1 -00 <br /> Site Proaect No. , <br /> • - Well Designation MW- 4 <br /> G� <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water in well box? YES 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) . 30' <br /> Well cover type . 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other D U-6.� <br /> General condition of wellhead assembly. Excellentoo Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4 " PVC bailerCentrifugal pump <br /> Sampled with: Disposal bailer:,_ Teflon bailer- <br /> Well Diameter 2" 4" - 611 8„ <br /> Purge Vol multiplier- 0 . 16 0 . 65 1 . 47 2 61 gal/ft <br /> Initial Measurement Rechar e Measurement <br /> Time :), Time 13 Calculated purge �. <br /> Depth of well : <br /> AftnePth to water. 3 Depth to water: Actual purge f, <br /> 1 �, <br /> Start purge Sampling time• 7 <br /> Time Temp. FIC pH Turbidity volume <br /> /3 z, Z7 o z�� 73f <br /> Z64 X74 73 z <br /> 251 / -73C,.o 3 <br /> Sample appearance Lock: <br /> Equipment replaced (Check all that apply) Note condition of replaced item <br /> 2 " Locking cap- Lock #3753 • 7/32 Allenhead• <br /> 4 " Locking Cap Lock-Dolphin: 9/16 Bolt* <br /> 6" Locking Cap: Pinned Allenhead (DWP) • <br /> Remarks . <br /> Signature <br />