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1 <br /> DOULOS EN XROMNTAL COMPANY SAMPLING INFORMIATION SHEET <br /> Client: Sampling Date: 7- + ` O� <br /> M Site: A2AL <br /> Project No. : <br /> NW <br /> /5'6401 PQM -Inti Ra( Well Designation; <br /> Is setup of traffic control devices required? tft- YES time: hours <br /> Is there standing water in well box? QW US Above TOC Below TCC <br /> Is top of casing cut level? NO 021L If no, see remarks <br /> Is well cap sealed and locked? No If no, see remarks <br /> Height of well casing riser (in inches) ': Ll <br /> Well cover type: 8" UV121" UV12" EMCO 8" BK_,X <br /> 12" BK 1211 DWP 1211 CNI 36" CNI Other <br /> General condition of wellhead assembly; Excellent d5k Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> PVC bailer X_Centrifugal pump <br /> 0 Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2"-4y--' 4-" 6" 8" <br /> Purge Vol . Multiplier: 0. 16 0. 65 1, 47 2 . 61 gal/ft. <br /> 1Initial <br /> e <br /> Time; � •� r Time; Calculated purge: ' 7 <br /> Depth of well ; > Depth to water: �/ Actua1 purge . <br /> Depth to water: <br /> Start purge: Sampling time: <br /> I 1 <br /> Time Temp. ,. E.C. pH Turbidity Vo ume <br /> I 3G 70 to a '7 - <br /> 2-J -7 <br /> 7 -2•J - r . V <br /> � � -�g �1• � ala 7 -� � `^ 3 <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 /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> i 6" Locking Cap; Pinned Allenhead (DWP) : <br /> 4F�Remarks: <br /> i <br /> Signature : <br />