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• 05119/2000 08:02 9167824 DOULO5 PAGE 10 <br /> SAMPLING INFORMATION SHEET <br /> Sampling Date: l <br /> Site ' -15O 0- V Project Na. <br /> .°Y ,.i /, t_��rl .,. <br /> ., - <br /> P <br /> Well Designation: <br /> IS setup of traffic control devices required? YES time: hours <br /> Is there stnndzng water in well box? NO015IFT00 Below TOC <br /> Is top of c,a.sing cut level? NO 1 no, see remarks <br /> Is well cap sealed and locked? � YES If no, see remarks <br /> Height of we7.1 casing riser (in inches) : <br /> Well cover type : g" UV 12" W 1211 EMCO 8"4 <br /> K <br /> 1211 9K 1211 DWP 12" GNI 36" CNI Other S <br /> General condit:Lon of wellhead assembly: Excellent ood Fair Poor <br /> Purging Equ4:-inent: 211 disposable bailer _ Submersible pump <br /> -2" PVC bailer Dedicated bailer <br /> _,4" PVC b$i'ler ate. Centrifugal pump <br /> Sampled wi.th : Disposal bailer: x. Teflon bailer: <br /> Well Di.amBter: 2" 41' 611 all <br /> Purge Vol . Multiplier: 0..^1666 0.65 1.47 2 . 61 gal/ft. <br /> Init ' Measurement Recha qe-Measurement <br /> Time: Time: 9 Calculated purge <br /> Depth of well ; . �; , Depth to water: Actual purge: <br /> Depth to water: <br /> Start purge: U Sampling time � y <br /> Time Imp. IE C. pH Turbidity volume <br /> 3'Z 69 774 <br /> a <br /> 61, 1 <br /> 06 <br /> Sample appearance: Lock: A <br /> Equipment replaced : (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap:._ Lock #3753 :....... 7/32 Allenhead: <br /> 4" Locking Cap.--� Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking cap : Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: � - <br />