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DOULOS MMIRO TAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: UltraMar Sampling Date• <br /> Site• Beagon J695Project No. : 94-695-01 <br /> _COQ S. -C.herokee TA&I _ Well Designation: NW-30 <br /> CA <br /> i c Getup og traf f ir, control device rircd? Y85 time: hours <br /> Is there sting rimer in stela bOX? - Y$8 Above TOC BelOW TOC <br /> %s top- o$ caning cut level? - - _ �� remarks <br /> Is Well cap sealed and locked? _ ��� � -See remarks <br /> Leight of Well casing riser (in inches) : `, Y;5 BK <br /> Well cover type: So UV_ <br /> 12 12 � 12�= �< ��"_ <br /> 1299 BK 12N DWP 120 CNI JV 360 <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: X2mp <br /> 11 disposable bailer Submersible <br /> bailer Dedicated PVC bailer <br /> 40 PVC bailer Centrifugal pump <br /> Sampled t►ith: Disposal bailer: Teflon bailer: <br /> Purges Vol. <br /> J.J7' . 2.63. <br /> /�t• <br /> 00- <br /> *Depth 0:9 uelll 4 -� to catew 8 a 6�6i Actual purgo: <br /> - ° A <br /> 4 Sampling time: -- <br /> m���� Volum <br /> 14 41 <br /> r" G 7 / <br /> Sample appearance: 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: � 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br /> S.� f-�- <br />