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{Qroz7r1M4 DOULOS <br /> PAGE 12 <br /> SAMORMATION' s <br /> Client: PLING INFSHEET <br /> i S.ite:� (j Sampling Data:-- C70— <br /> = Project No, : <br /> We11 Designation: <br /> IS setup of traffic <br /> is there standing water in <br /> 1 is to YES time: hours <br /> p Qf cos j.pg ct1t level? YES Above TOC Below T <br /> Is well cap sealed OC <br /> Height of well and locked? NO If no, see remarks <br /> Well cover type:l casing riser (in inches) : YES _ If no, see remarks <br /> rr g W 12 rr <br /> 12 BKS 12" DWP 12'T CNI w�`� r� 1211 EMCD_. $" BK <br /> General condition of wellhead assembl 36 CNI�_ other <br /> E ui men, : �� y: Excellent a Fair poor <br /> Purgingq P <br /> �-- 2 disposable bailer <br /> -��z" PVC bailer ,...Submersible pump <br /> — _ 4" PVC baiJer Dedicated bailer <br /> Centrifugal pump <br /> Sampled with: Disposal bailer: <br /> Teflon bailer: <br /> Well Diameter: 2+1 3'�K ►� <br /> ;. �— 4 b it 8 rr <br /> Purge Vol,`; Multiplier: 0. 16 <br /> itia em <br /> Meas e n t 0. 65 1.47 2 . 61 <br /> Time: ar ensu ame t gal/ft= <br /> ' O Time; : c> <br /> Depth of well : µ ���. /� Depth to water: 3 0j, calculated pure: <br /> Depth to water Actual g : 1 <br /> Start purge: / D <br /> --= Sampling time; —LLL-0 /L <br /> Time Temp. E. C. <br /> PH Turbidity Volume <br /> r <br /> ` S �) yl0 <br /> Sample. appearance: <br /> Lock: <br /> Equipment replaced: <br /> 211 Lacking Cap: (Check all that apply) Note condition of replaced item <br /> � <br /> 4t1 Socking Cap: Lock #3753_ 7/32 Allenhead:�� <br /> 6" p Locking' Cd Lock-Dolphin;— 9/16 Bolt: <br /> Pinned Allenhead (DWP) :— <br /> Remarks: <br /> Signature: <br />