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DOUL013 ENVIROMKMTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: UltKamar Sampling Date: <br /> Site: Beacon #625Project No. : 94-695-01_ <br /> 90Q S. Cherokee Lan Well Designation: KW-of <br /> C <br /> Is setup of traffic control devices r0quigcd? Y&S t.ime:_ hours <br /> Is there standing grater in well box? Y Abava TOC Below TOC <br /> Is top of casing out Level? t` aYene remarks <br /> Is well cap sealed and locked? aee remarks <br /> 71 <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 UV 12N UV 12"7 <br /> 1214 BK 1211 DWP 12" CNI 360 CNI OthAT <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 2C0 disposable bailer Submersible pump <br /> 201 PVC bailer Dedicated bailer <br /> 40 PVC bailer t Centrifugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> We 11 Diameter° n 4w = 60 8a <br /> Purge Vol. Multiplieri 0e2A 0e65 1047 2.61 gag/gt. <br /> Initial. MeasureMMI <br /> Time: 7t3 - T .- targe: <br /> Depth of well: 76,.ZZ Dopth to emor: dt&� _ Actin 1 Aga <br /> Depth to water: 67--a-­ <br /> Start <br /> 7--a--- <br /> Start ;urge: /3.13 - Sampling tiara: /-- <br /> Time Temp. 1Z.C. ]PIE Turbidity Voluno <br /> 12-22 1 61. 1- <br /> 1 l-i 6 6 7 U, <br /> 111� 0 13 7 <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 214 Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 441 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: '` <br />