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DOOLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> • Client: Sampling Date:1a/4�_q If <br /> Site: Project No. := clU -696'01 <br /> ;:+n Well Designation: 4W 34 <br /> Is setup of traffic control devices required? 0 YES time: hours <br /> Is there standing water in well box? O Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO E If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" UV_ 12" UV12" EMCO 8" BK,__ <br /> 12" BK 12" DWP 12" CNI 36" CNI Other-MijO11 <br /> General condition of wellhead assembly: Excellent oo 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: Disposal bailer:_ Teflon bailer: <br /> Well Diameter: 2" 4" 6" 811 <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: 30X- Time: U)-D _ Calculated purge: 5..z <br /> Depth of well: .D Depth to water: b Actual purge: <br /> Depth to water: 55,lci <br /> Start purge: 3314 Sampling time: WS <br /> Time Temp. E.C. pH Turbidity Volume <br /> 34 ig 73.9 6141 . 6i 1 <br /> 3 ,6 i 1 7 Z <br /> fro q 7.j 7 <br /> 406 73L..-5 7 g l 7. 39 ---�- y° <br /> Sample appearance: Lock: 4753 <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 03753: 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: �( _ <br />