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M <br /> DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> r <br /> j Site: r Project No. ; <br /> cor <br /> OLI n l�o� Well Designation: A W"6 <br /> Is setup of traffic control devices required? 0 YES time: hours <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : L4 <br /> Well cover type: 81' W 12'1 W 12" EMCO 8'1 BY _ <br /> M 12" BK 12" DWP 12" CNI 36" CNI ther <br /> General condition of wellhead assembly: Excellent 04 Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer —Centrifugal pump <br /> 1 <br /> Sampled with: Disposable bailer:,IL. Teflon bailer: <br /> Well Diameter: 211 Y 4+0 611 8 ft <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft <br /> 1Initial MeasurpMents e ent <br /> Time: AW Time: 17LI14 Calculated purge:4 <br /> Depth of well ; ],0.03 Depth to water: 14.03 Actual purge: <br /> Depth to water: qX1 <br /> Start purge: q 3 f Sampling time; 145 <br /> 1 <br /> Time Temp. E.C. pH Turbidity Volume <br /> jq 61.E / alb 73) I <br /> 1 9q'0 6 /0 ?3/ <br /> gL41 646 7i-1 <br /> 1 <br /> Sample appearance: - --.. Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt. <br /> i 6" Locking Cap; Pinned Allenhead (DWP) : <br /> Remarks: <br /> 1 <br /> Signature: <br />