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• s t t i t (`1qsYJ t r. i <br /> } <br /> I <br /> DOULOS EN'9IRONXENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Sampling Date: <br /> Client. <br /> • <br /> Site: r Project No. : <br /> / 6 00 ., 4L Lee <br /> ia,l Well Designation: /� w <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? NO M If no, see remarks <br /> Is well cap sealed and locked? NO OM If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 LTV 1 1211 W 121' EMCO 811 BK� <br /> 1211 BK 1211 DWP 1210 CNI_ 3611 CNI Other <br /> General condition of wellhead assembly: Excellent < Fair Poor <br /> Purging Equipment: 210 disposable bailer Submersible pump <br /> 2t1 PVC bailer Dedicated bailer <br /> 411 PVC bailerCentrifugal pump <br /> r Sampled with: Disposable bailer:,X Teflon bailer: <br /> Well Diameter: 21!,_„2- 411 6" 8" <br /> Purge Vol . Multiplier: 0 . 1.6 0. 65 1 . 47 2 . 61 gal/ft <br /> r <br /> Time: = 19 , 57 Time: - Calculated purge; s '® <br /> Depth of well : Depth to water: Actual purge; tel <br /> Depth to water: 7 <br /> Start purge : 1 1 fl Sampling time: P / <br /> 1 <br /> Time Temp. .. E.C. pH Turbidity Volume <br /> lit/ 16q /00 7 I <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap: Lock #3753 : 7/32 Allenhead. <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature : <br />