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DOOLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client : C ��„ _ Sampling Date• <br /> Site : 6 / Project No. - <br /> m4 Well Designation <br /> Is setup of traffic control devices required? � YES time - <br /> Is there standing water in well box? hours <br /> Is tap of casing cut level? � YES Above TOC Below TOC <br /> Is well cap sealed and locked' N0 If no, see remarks <br /> NO <br /> Height of well casing riser (,in inches E If no, see remarks <br /> Well cover type : 8 " " W UV 12 f1Q 12" EMCO 81 <br /> ' BK- <br /> 12 11 BK 12" DWP ­-1-21r��`CNI� 36" CNI Other <br /> General condition of wellhead�a`ssembly: Excellent <goo Fair Poor <br /> Purging Equipment : 2" disposable bailer X Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with , Disposable bailer: f P Teflon bailer <br /> Well Diameter: 211 411 611 <br /> 8 „ <br /> Purge Vol Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal/ft <br /> . n t al Measureme t Rechr e easurement rJ <br /> Time 7' Time: O ^_ Calculated purge <br /> Depth of well 6S O Depth to water: Actual purge <br /> Depth to water , <br /> Start purge , /D / Sampling time: J0 y <br /> Time Temp. E. C. pH Turbidity Volume <br /> Po <br /> /0 ' <br /> W3 7 29 - 2 S <br /> Sample appearance- _�Q�1+ ,�•— Lock, <br /> Equlpment replaced: (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock 03753 : <br /> Ca 7/32 Allenhead , <br /> 4 " Locking P� Lock-Dolphin: 9/16 Bolt <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks . <br /> Signature , <br />