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DOULOS ENVIRONMENTAL COMPANY S.AMPLINI , INFORMATION SHEET <br /> Client: an_c4„ Sampling Date: <br /> 3 Site: a /30 Pro3ect No <br /> w 6 � Well Designation ^'I � <br /> G� <br /> Is setup of traffic control devices required? W YES' time: hours <br /> Is there standing water in well box? Qld) Y 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) : <br /> well cover type: 8" W 12" UV_ 12" EMCO 8" 5K <br /> 12" 8K_ 12" DWP l2" CNY 36" CNI Cather _. <br /> General condition of wellhead assembly: Excellent _czc FaIr Poor <br /> Purging Equipment: 2" disposable bailer _Submersible pump <br /> 2" PVC bailer -Dedicated bailer <br /> PVC bailerCentrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter; 211- 4" 6" S"mow <br /> F <br /> purge Vol. Multiplier: 0. 16 0.65 1. 47 61 gal/ft. <br /> initial --all-sa-ment h ,11gasurement <br /> Time-, Time- Calculated purge <br /> Depth of well: 7 Q Depth to water; Actual purge: <br /> Depth to water: <br /> 3 start purge: sampling time: <br /> Time Temp. E.C. pH 'Turbidity Volume <br /> It <0 -70' 3 <br /> �l •l ]�• <br /> 371 7-0" � <br /> Sample appearance; L�&G.c_� 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 Solt: <br /> 6" Looking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br /> CO 39Vd so-inoa V906Z8L3T6 8b 60 0002/Ol/B0 <br />