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10/11/2000 13 38 9167629054 DOULOS PAGE 10 <br /> Domos E3PVIikOZllumi L col yANY SAMPLING INFQRMATION SHEET <br /> Client: Sampling Date: - --0� <br /> 1 Site: Project No. : <br /> D1 . 140E--144 Rd Well Designation: NV-i4 <br /> A <br /> Is setup of traffic control devices required? a YES time: hours <br /> To there standing water in well box? Ag YES Above TOC Below TOC <br /> Is top of casing 'gut level? No If no, see remarks <br /> Is well cap sealed and locked? D M if no, gee remarks <br /> Height of well casing rimer (in inches) : <br /> Well cover type 8" W 1Z" W 12" EMCO 8" BK_-:f_ <br /> 12" BK_ IF" DWP 12" CNI„ _ 36" CNI Cher <br /> General condition of wellhead assembly: Excellent foaf Fair Poor <br /> Purging Equipmer- 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 41' PVC bailer,/ Centrifugal pump <br /> t Sampled with : Disposable bailer:x Teflon bailer: <br /> Well Diameter: 2"� 4" 6" 8" <br /> Purqe Vol. Multiplier: 0. 16 0.65 1.47 2.61 gal/ft. <br /> 0 OInitial e su ementRecharge t <br /> Time; Iq S 9, Time: Calculated purge: 7 <br /> Depth of well. /3Depth to water: Actual purge: ? ti <br /> Depth to water <br /> Start purge: 1 F sampling time: l 0 5 1' <br /> Time Temp. E.C. pH Turbidity Volume <br /> 32 "-� <br /> Sample appearance; _Q.:1,. Lock: <br /> f <br /> Equipment replace+ (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 Solt: <br /> 6" Locking car -__ Pinned Allenhead (DWP) : <br /> Remarks: _„ <br /> Signature: <br /> I <br />