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10/11/2000 13 38 9167829054 DOULOS PAGE 11 <br /> DODLOs ENnY 018[ hL C01IRVY SAMPLING INFORMATION SHEET <br /> Client, 4MJft Ca, Sampling Date: <br /> el.Ao x. Project No. • <br /> 6 00n Well Designation: MW— .5 _ <br /> C. <br /> 1 Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? IM If no, see remarks <br /> Is well cap sealed and locked? NO Ito If no, see remarks <br /> Haight of well casing riser (in inches) : 4 _ <br /> Well cover type 8" UV 12" W 12" EMCO_,__._ 8" BKA— <br /> 1 12" BK 1'2" :)WP_ 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: ExcellFair Poor <br /> Purging Equipmerr 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4'f PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer: Teflon bailer: <br /> Well Din-meter: 2"A— 4" 6" e" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2. 61 gal/ft. <br /> Initial MeasureMn,,et}t <br /> 1 Time: OG Time: 1p4L Calculated purger <br /> Depth of well IL-6f13 Depth to water: Actual purge: E7 <br /> Depth to water: , <br /> start purge: f 01 4 Sampling time: /DltL <br /> 1 Time rTemp. E.C. pH Turbidity Volume <br /> /o r, <br /> JG72- 7,544 j <br /> 10A Li, MEL 7st � <br /> 10 7 L6 7,5o <br /> Sample appelarance: ��, Lock: <br /> 1 <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 /> 611 Locking Gar _ Pinned Allenhead (DWP) : <br /> 1 � <br /> Remarks: <br /> { <br /> r <br /> Signature: { - —• <br /> 1 <br />