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10/11/2000 13 38 9167829054 DOULDS PAGE 09 <br /> I <br /> DOULos alvei*OM(MAL CO3 PAY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: C1%10-00 <br /> 1 <br /> Site-4477-?e Project No. : <br /> G 10k-I4n Bid well Designation: <br /> 4 <br /> 1 Is setup of traffic control devices required? 40 YES time: hours <br /> Is there standznq water in well box? YM Above TOC Below TOC <br /> Is top of casing cut level? N If no, see remarks <br /> Is well cap sealed and locked? y xf no, sea remarks <br /> Haight of wall casing riser (in inches) : <br /> Well cover type. 9" UV 12" UV12" EMCO 8" BK-,r^ <br /> 1 12" BK 1`" DWP 12" CNI 36" CNI ther <br /> General condition, of wellhead assembly: Excellent=j6 Fair Poor <br /> Purging Equipmerr 2" disposable bailer submersible pump <br /> Z" PVC bailer Dedicated bailer <br /> 4" PVC bailer --Y-Centrifugal pump <br /> i Sampled with Disposable bailer: � Teflon bailer: <br /> well Diameter: 2" ( 4" 6" 8" <br /> Purge Vol. Multiplier; 0. 16 0.65 1.47 2 .61 gal/ft. <br /> Wnitial_Measurter+� nime: Io64t Time: I J I Calculated purge: 3. <br /> Depth of well: ;s Depth to water. Actual purge;-SA4 <br /> Depth to water.-.7-21 purge- Sampling time: 111 <br /> 1 Time Temp. B.C. pH Turbidity Volume <br /> 162s 7q8 <br /> t6 )-b 7qa 3 <br /> Sample appearance: Lock: <br /> Equipment replac-PH (Check all that apply) Note condition of replaced item <br /> 211 Locking Car= - Lock 03753: 7/32 Allenheajd; <br /> 4" Locking cap T Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap- Pinned Allenhead (DWP) : <br /> Remarks: <br /> f r <br /> Signature: 1+' <br /> 1 <br />