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07/25/2006 11 16 9167829654 DOULOS PAGE 01 <br /> DOULOS nM3:RONKENTA.L CoMpANY SAMPLING INFORMATION SHEET <br /> Client: —c7Sampling Date:_ <br /> Site; 2g_:_2 <br /> _6_ Project No. : <br /> Well Designation.- <br /> Is <br /> esignation:Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? clxp S Above TOC Below moc <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO YE If no, see remarks <br /> Height of well easing riser (in inches) : <br /> Well cover type. B" uv 12" UV 12" EMCC 8" BK <br /> 12" BK _ 12" DWP 12" CNI 36" CNI ther <br /> General condition of wellhead assembly: Excellent fla Fair Poor <br /> Purging Equipmer-I ; _2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with - Disposable bailer: � Teflon bailer: <br /> Well Diameter: 2"-A 411 611 8 f <br /> Purge Vol. Multiplier; 0. 16 0. 65 1. 47 2 .61 gal/£t. <br /> InitialAusurement Rechggge MagpuXement <br />• Time: 10 OY Time: / <br /> Calculatedur e:� <br /> : ',a 2 � <br /> Depth of well: _ .;U Depth to water - Actual purge: <br /> Depth to water: J'1 . 22 <br /> Start purge: / 0 5 ID Sampling time: 10 Y O _ <br /> Time Temp. E.C. pH Turbidity Volume <br /> Sample appearance; 4 V4 lk"� Lock: <br /> Equipment replaced_ (Check all that apply) Note condition of replaced item <br /> 211 Looking Cap:__ Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap--- Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap._ Pinned Allenhead (DWP) :� <br /> Remarks: <br /> Signature: / <br />