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10/11/2000 13 38 9167829054 DOULOS PAGE 12 <br /> DOM05 ENVz*0VXM"XL COI MY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date:, <br /> 1 <br /> Site:Aka, ���.,,�. Project No. • <br /> /S 6 DLJ. /L/arrrlan add Well Designation: M w' _ <br /> It <br /> 1 <br /> Is setup of traffic control devices required? 0 YES time: hours <br /> Is there standing water in well box? Y Above TOC Below TOC <br /> Is top of casing cut level? NO Yf no, see remarks <br /> Is well cap sealed and locked? N Zf no, see remarks <br /> Height of well casing river (in inches) : <br /> Well cover type: 8" VV 12" W 12" EMCO 8" BK-4- <br /> 12" BK 12" DWP 12" CNI 36" CNI her <br /> 1 General conditxor or wellhead assembly: Excellent loop Fair Poor <br /> Purging Equipment 2" disposable bailer Submergible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" Pvc bailer Centrifugal pump <br /> Sampled with. Disposable bailer:- -dTeflon bailer: <br /> Well Diameter; 2"-4-- 4„ 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 .62 gal/ft. <br /> harge 924AUrement <br /> 1 Time: q5 Time: is Calculated purge-.-53 sort <br /> Depth of well: je o Depth to water:_ Actual purge:M 4 <br /> Depth to water: iff 2d <br /> start purge: � ; -�- sampling time: 1030 <br /> Time Temp. E.C. phi Turbidity volume <br /> �01- - 1G R L .Y? 1, <br /> sample appe6 rance: 1�601-n Lock: <br /> 1 <br /> Equipment replaced (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap._ Lock 13753 : 7/32 Allenhead: <br /> 411 Locking Cap , Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap Pinned Allenhead (DWP) : <br /> Remarks: <br /> c' <br /> Signature: <br /> 1 <br />