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DOULOS ENVIRONMENTAL COMPANY SAMPL 1 t4 - INFORMATION SHEET <br /> Client; - .�-- sampling Date �f= -- 16-00 <br /> Site: q6eepa 13 C7 Project No <br /> 906 l A Well Designat ion. <br /> Is setup of traffic control, devices required? 4& YF,3 time. hours <br /> Is there standing water in well box? YES above TOC Below TOC <br /> Is top of casing cut level? NOIf no, see remarks <br /> Is well cap sealed and locked? NO S, If no, see remarks <br /> Height of well casing riser (in inches) : _ <br /> Well cover type; 8" W 12" UV__ 12" EMCC,^__ 8't BIC _- <br /> 12" BK 1201 DWP 1211 CNI _ 3611 CNz _ �)Cher- <br /> General condition of wellhead assembly: Excellent 565_-d Fair Poor <br /> Purging Equipment: 211 disposable bailer X_-_,Submersihle pump <br /> 2" FVC bailer __-Dedicated bailer <br /> 4" PVC bailer centrifugal pump <br /> Sampled with: Disposable bailer: '5_1 <br /> p Teflon ba , er; <br /> Well Diameter; 21' 4" 611 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 61 gal/ft.. <br /> Initial P s <br /> Time: Time: Cal :, c+ted purge. <br /> Depth of well; �- Depth to water: p'// At~*ual purge: <br /> Depth to water: 9- <br /> start purge:1d -CLCD sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> f <br /> 10 ' 05 �7� Os 0 T-�0/0,110 3 - o p <br /> /0< rs 149�3 `'74-6 _ - m <br /> Sample appearance: a+.-t.r- Lock: ~�' 1 <br /> Equipment replaced: (Check all that apply) Note conditiun of replaced item <br /> 21+ hocking Cap: Lock #3753 : _ /32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin; 9/16 Bolt; <br /> 6" Locking Cap: Panned A! _cihead (DWP) :� <br /> Remarks: <br /> signature; <br /> 90 39dd sonnoa V596Z8L9Z6 eti se 03OZ/vz/8e <br />