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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Sampling Date: 3 )-J-I <br /> Site: G ,�... Project No. : q L.#r 67 <br /> 1006. ., S�11 Well Designation: MW <br /> N,C.•riC{. <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 E If no, see remarks <br /> Height of well casing riser (in inches) : 3 <br /> Well cover type: 811 UV 12" UV 1211 EMCO 811 BK <br /> 12" BK 1211 DWP 1 1211 CNI=_ 36" CNI Other <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment: - 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:_ Teflon bailer: <br /> Well Diameter: 2"� 419 644 g 11 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge. Measurement <br />.DeptTime:_... J13� Time: Calculated purge: <br /> to <br /> h well: 5� I� Depth o water: � , � Actual purge <br /> Depth to water: K 1,r- <br /> Start purge: �� d ._ Sampling time: 600 <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance: Lock: 75 <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 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 />