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DOULOS ENVIRONMENTAL COMPANY SAMPLIIv INFORMATION SHEET <br /> Sampling Date- <br /> site: l Project No <br /> 7106 <br /> A Well Designate on 11 Vim' — 7 <br /> �rw nY11MAA1�A <br /> j Is setup of traffic control devices required? YES tame:- hours <br /> Is there standing water in well box? AID YE Above TOC Below Too <br /> Is top of casing cut level? NOzf no, see remarks <br /> Is well cap sealed and locked? No ES zf no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type; 81' UV 12" UV12 EMCO� _ " SK <br /> 12" SK 12" 17WP_ 12" CNI 36" CNI_ other EAQ22 <br /> General condition of wellhead assembly; Excellent c,"o`� Fair Poor <br /> Purging Equipment: 2" disposable bailer `- Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bas -LF-Ir. <br /> Well Diameter: 2"-X— 4" 6" a" <br /> f <br /> Purge Vol. Multiplier: 0. 16 0.65 1. 47 111161 gal/ft. <br /> Time: �' Timeo � Cal(ru., aced purge:-1-7- 0 <br /> Depth of well: Depth to water: Actual purge: <br /> Depth to water: <br /> Start purge: q - egg Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> x,0 6 -7 ` (0 6 - <br /> q . 0S 7f� 3 10 S 6,186 _ 2 <br /> q = 10 1l - 0 /0LJv 6� 7 �-- <br /> Sample appearance: _ C-?,-p . _. Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Looking Cap: Lock 03753 : _,/32 Allenheads <br /> 4$4 Looking Cap: Lock--Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: _ <br /> Signature: <br /> 60 39V8 so-inoa b606ZBL9TG 8b 60 0002/bT/80 <br />