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DOOLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: 3 <br /> Site 6 _/ _ Project No. <br /> se4mL Well Designation: � w <br /> CA <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level's 0 If no, see remarks <br /> Is well cap sealed and locked? N06 If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" W 12" EMCO 8" SK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other 11, f?/I0 <br /> General condition of wellhead assembly: Excellent 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 bailer: <br /> Well Diameter: 2" 4"74 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0.77766555 1 . 47 2 . 61 gal/ft <br /> Initial Measure]nent Recharge Measurement <br /> Time . ! 2 ' !I72 , Time: _, / ,g Calculated purge • 77 <br /> Depth of well : Depth to water: 3 4f Actual purge . <br /> Depth to water : �( 1 S' <br /> Start purge . 3 ! 0.012- Sampling time: 3 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 3 ' 031 .a 1 1 g /U 1 7- / <br /> 3 =0568 . 3 18q9 -7Y <br /> 3=07 G 5190 `1 - 33 3 <br /> 10 <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 />