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..s.-...,~Y�..,,..w�'S'g7'�'r'!' ^11wr.-r w. �vm,•+---rw.ir!"X.AtIPtRMIA AR�ia. w .... <br /> - `r7.•�4nli'MrLr+4!'.lq,�l`��t .T.�,(�J <br /> ic i i ,t�•;�'i�ln�rdi. 4,rµ <br /> , <br /> 1 <br /> DOULOS ENVZRO=XTAL COMPANY w SAMPLING- INFORMATION SHEET <br /> Client:.r C& ' SamplIng Date: <br /> i <br /> Site: f Project No. : <br /> / <br /> 5'600 �, �'1 Af���n /QW Well Designation: w <br /> It <br /> Is setup of traffic control devices required? <JW YES time: hours <br /> Is there standing water in well box? Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? N YE If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV 12" UV 12" EMCO g" BK � <br /> 12" BK 12" DWP 1211 CNH 36" CNI Other <br /> General condition of wellhead assembly: Excellent C'NjD 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:-A— Teflon bailer: <br /> Well Diameter: 211� 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0. 65 1. 47 2 . 61 gal/ft . <br /> Ole Time: I . .7 Time: M0 ^ Calculated purge. <br /> Depth of well : Iq S Depth to water: Actual purge : <br /> Depth to water: ' <br /> ZI <br /> Start purge; / - 2 Sampling time: [ = 3 <br /> 1 PE.C. H Turbidity Time Temp. .. Y Volume <br /> ; i -70 0 9 S 6 Q 6) / <br /> . 25 <br /> 7e) [ 8S0 - 80 — z <br /> 1 <br /> r : 2 G o • 9 14 I G 70 3 <br /> 1 . <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 /> 1 <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> 1 <br /> Signature: <br />