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Jy4 u`JUJ'4 DOULOS <br /> PAGE 13 <br /> j <br /> Client: SAMPLING INFORMATION SHEET <br /> Site. $D sampling Date: �� Q'0 <br /> { Pro)ect No. : <br /> - - Well Designation: <br /> Is setup of traffic cont <br /> Is there standing water control devices required? <br /> IS top at' casing cit letrei,well box? xEs time:�� hours <br /> ix Y Above TOC Below TOC <br /> Is well cap sealed and locked? N If no, <br /> Height of- well casing riser see remarks <br /> well cover type: 8„ (in inches) : ES If no, see remarks <br /> 12" EK12'F W 12 r� <br /> 12" ,�Wp �2 n EMCO 8'�� HIC <br /> General condition of-- CNz� 36" CNI -"`�T-- <br /> wellhead assembl er ^' <br /> Y: Excellent po Fair Poor <br /> Purging EquS_pment:: —zti disposable bailer -Submersible <br /> PVC bailer ,� ible pump <br /> Orr PVC bailer Dedicated bailer <br /> ,Centrifugal pump <br /> Sampled with: Disposal bailer: <br /> Teflon bailer: <br /> Well Diameter: 20, it -�-- <br /> `�"� 41F 6'� _ sit <br /> Purge Vol ,' Multiplier. 0. 16 <br /> I tial Measurement 0.65 1.47 2 . 61 galJft. <br /> Time: ".p a eas eme <br /> Depth of well : �* e <br /> Time: Calculated purge: / -.5, <br /> Depth to waterDepth to water: <br /> ACtual purge; <br /> Start purge:_j Sampling time: Y{ <br /> Time Temp. E.C. <br /> PH Turbidity Volume <br /> • �' ) y r � s ya �r� � <br /> Sample`' appearance: Lock: <br /> Equipment replaced, (Check all that apply) <br /> app 1 <br /> y) N2" Lacking cap: _ Lock #3753ote condition <br /> of <br /> rep <br /> lac <br /> ed item <br /> 4" Locking Ca'� Lock-Dolphin: <br /> 7/32 Allenhead: <br /> 6" Locking Ca : 9/I6 Bolt. — <br /> Remarks: Pinned Allenhead (DwP) : <br /> Signature: <br />