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10/11/2000 13 36 9167829054 DOULOS PAGE 07 <br /> DOUL09 EWIAONNEIT AL COMPAW SAMPLING INFORMATION SHEET <br /> Client: fgb%4,, Sampling Date: `1-0 '00 <br /> Site: .i-_ d44A= ezA.►g. Project No. : <br /> Ili �t1 00 ,-�' _Pat /goon Well Designation:/Vilel <br /> Is setup of traffic control devices required? 4 YEs time:_______ hours <br /> is there standtnq water in well box? go yZs 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) : <br /> Well cover type. 8" UV 1a" UV- 12" EMCO B" BK <br /> 12" BK 12" OWP 12" CNI 36" CNI er <br /> General condition of wellhead assembly: Excellent Goo Fair Poor <br /> Purging Equipment 2" disposable bailer submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4" PVC bailer _.-_)4_Centrirugal pump <br /> Sampled with Disposable bailer: Teflon bailer: <br /> Well Dihmeter: x" 410_ r _ 6" 9" <br /> , Purge Vol. Multiplier: 0. 16 0.65 1.47 2. 61 gal/ft. <br /> Initial Measuret!Prt Regharae Measurement <br /> Time: 1015 Time: fife Calculated purge: <br /> Depth of well. q, LJ Depth to water: 10tk I Actual purge: &U__!r <br /> Depth to gaster <br /> start purge: sampling time: 115�i <br /> Time Temp. E.C. pH Turbidity Volume <br /> t 721_ 6 3 <br /> Sample appoiarance: C.A Lock: f <br /> Equipment replac-ed (Check all that apply) Note condition of replaced item <br /> 211 Locking Cap-_ Lock #3753: 7/32 Allenhead: <br /> 4" Locking Cap- Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap:_ pinned Allenhead (DWP) : <br /> 1 <br /> Remarks. <br /> Signature: <br /> 1 <br />