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DOOLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:_ - _ Sampling Date: 2 d ~ 0o <br /> 16 Site :_ 13_a Project No. <br /> -7q26 A/ Well Designation: ~ 0 <br /> CA j <br /> Is setup of traffic control devices required? eO YES time: hours <br /> Is there standing water in well box? YES 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) : v <br /> Well cover type: 8" UV12" UV12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Goodai Poor <br /> Purging Equipment: 2" disposable bailer X Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with : Disposable bailer: S Teflon bailer: <br /> Well Diameter: 2"_ 4" 6" 8" <br /> ? Purge Vol . Multiplier: 0116 0 . 65 1. 47 2 , 61 gal/ft. <br /> Initial Measurement Recharcre Measurement <br /> Time: Time: 3 Calculated purge: <br /> Depth of well : -71 Depth to water. '1 0 Actual purge . <br /> Depth to water•=LZd 2 <br /> r <br /> Start purge: Sampling time: S1/ 0 <br /> s <br /> Time Temp. E. C. pH Turbidity Volume <br /> 31 16, 25 <br /> Sample appearance: C -.. SLn Lock: Y�11 11 T if $2 <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 /> 61' Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature , <br />