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05/19/2000 08:02 916782gO54 DOULOS PAGE 11 <br /> SAMPLING INFORMATION SHEET <br /> Client:^_ _ Sampling Date: ^ / -©0 <br /> Site -_�-$(� Project No. <br /> LO-C4 A -P <br /> - Well Designation: AA4.A- -- Ca <br /> IS setup of tr,nf'fic control devices required? YES time: _ hours <br /> Is there standing water in well box? `Ap ve Below TOC <br /> Is top of casi.279 cut level? NO no, see remarks <br /> Is well cap sealed and locked? YES If no, see remarks <br /> Height of well casing riser (in inches) ; _ <br /> Well cover type : 8" W 12" UV-1 12" EMCO " HK <br /> 12" $K 1a" DWP 12" CNI 36" CNI Other <br /> General cond.it .on of wellhead assembly: Excellent Fair pooh <br /> Purging Equipment-— —2" disposable bailer Submersible pump <br /> �2" PVC bailer -Dedicated bailer <br /> �4" PVC bailer _,.2!S,_Centri£ugal pump <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2"./-- 4" 6" 8,t <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> In 'tial Measurement Jlgcharcre M asu eme <br /> Time: 3 C �' Time: nt Calculated purge; S- 45; <br /> Depth of well ; 7- Depth to water:-J 9. 1 Actual purge: <br /> Depth to water: <br /> Start purge,_ _ `O Sampling time:— <br /> Time Temp. E.C. pH Turbidity Volume <br /> 41 7, <br /> Sample appearance: Lock: <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:_ bock-Dolphin 9116 Holt: <br /> G" Locking Cap: binned Allenhead (D WP) : <br /> Remarks: <br /> Signature: <br />