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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: AAA-d&, Project No. : zltr S 0) <br /> 0,0 S Well Designation: M W-14 <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in we- ! box? 4 YES Above TOC Below TOC <br /> Is top of casing cut level? NO S 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) : <br /> Well cover type: 811 W 1211 W 1211 EMCO 8f1 BK <br /> 12" BK 1211 DWP 1219 CNIT 3611 CNI CLther <br /> General condition of wellhead assembly: Excellent oo 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:-=X Teflon bailer: <br /> Well Diameter: 211 4" 6" $11 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 11 1, . Time: Calculated purge: .L <br /> Depth of well: Depth to water: d C9 Actual purge: 1,41k, <br /> Depth to dater: <br /> Start purge: 3Kf_ Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> r410 63. Z� 12--1 0 7- 61 �--� <br /> 63-6 1'-',g 7 6/ --- Ll <br /> Sample appearance: czkknn Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753: 7/32 Allenhead: <br /> 41° Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 610 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />