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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: U-6-47 <br /> Site: yak-r-�-, 4/9 Project No. : <br /> a350 Well Designation: W- <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? ;3YES Above TOC Below TOC <br /> Is top of casing cut level? _ NO <� If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : _ R, <br /> Well cover type: 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI r,,Qther <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipment: 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: 21+ 4 i ::K 6" 8" <br /> Purge Vol. Multiplier: 0.16 0.65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br />* Time: 171-2 _ Time: rso _ Calculated purge: <br /> Depth of well: C711 Depth to water: Actual purge: �- <br /> Depth to water: 5f iJT <br /> Start purge: 750 Sampling time: ?0 6 <br /> Time Temp. E.C. pH Turbidity Volume <br /> 753 <br /> 7556 7,L6 <br /> ) 071 71r <br /> Sample appearance: Lock: r ' <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 /> 61' Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />