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DOULOS ENVIRONMENTAL COMPANY SAMPb_1v- INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: Qrl1�C�� f 3 __ Project No <br /> Z106 AL 9ZJ-O Well Designat o , 10 <br /> GA <br /> Is setup of traffic control devices required? YE.' time: hours <br /> Is there standing water in well box? KN YF <br /> `` kbove TOC Below TOC <br /> Is top of casing out level? NO 4LW If no, see remarks <br /> is well cap sealed and looked? NOO-Esy If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: B" UV12" UV 12" EMCo _ 8" BK <br /> + 12" 5K_ 12" DWP 1211 CNI 3601 CNI Other <br /> j General condition of wellhead assembly: Excellent tT�nd Fair Poor <br /> Purging Equipment- z" disposable bailerbmersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: ,L Teflon ba_ or- <br /> Well <br /> arWell Diameter: 2" 4 Of 6" <br /> Purge Vol, Multiplier: 0. 16 0. 65 1 47 61 gal/ft. <br /> Initial nt <br /> Time: '. co 7 r. 7 Time:_1 ' Q Ca-1::u�rtted purge: 2 . <br /> Depth o well: f Depth to water: ` �a Actual purge: :2` t, <br /> Depth to water:_ <br /> Start purge: Q ' �� Sampling time: <br /> , <br /> Time Temp. E,C. pH Turbidity volume <br /> 71 (081 a <br /> T,ZK 7t . 3 (0 66 G - <br /> `� 6- 70 -3 <br /> Sample appearance; Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced Item <br /> 2" 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 /> 1 39bd So-fnoa b506ZBL1T6 8b 60 0007'/VT/80 <br />