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r .a <br /> 1 <br /> DOOLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> 1 <br /> • Siterr Project No. : <br /> I n Well Designation: <br /> t ai <br />/ Is setup of traffic control devices required? t <br /> YES time: hours <br /> Is there standing water in well box? Y Above TOC Below TOC <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? �E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8T' UV12" W 12" EMCO 8" BK <br /> 1211 BK 1211 DWP 12T' CNI 3611 CNI Other o4ar r / 5 <br /> 1 General condition of wellhead assembly: Excellent 6S2 Fair Poor <br /> Purging Equipment; 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _ Centrifugal pump <br /> 1 sampled with: Disposable bailer Teflon bailer : <br /> Well Diameter: 2"7X-- 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0, 65 1. 47 2 . 61 gal/ft . <br /> Initial e <br /> 1 <br /> Time : 7.3 Time ; Calculated purge: .c. <br /> Depth of well ., 49479 Depth to water: - Cl 0 Actual purge ; <br /> Depth to water: T. <br /> rT Start purge: �a d Sampling time: � <br /> 1 Time Temp. E. C. pH Turbidity Volume <br /> 'S <br /> '47 q o <br /> 1 2 r l 07 3 .- <br /> 1 Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock X3753 : 7/32 Allenhead : <br /> 4" Locking Cap: Lock-Dolphin; 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> __— ___-.—�.--__ _._. _ i w�i wrw!•�i i u i i .r i�rr�i.rrrrrrir�nr. r�rr <br /> Remarks: <br /> Signature: <br />