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r DOOLOS ENVIROI*ENTAL COKPAKY SAMPLING INFORMATION SHEET <br /> Client:,,_ , __�___� Sampling Date: lb-/4-ql <br /> Site: 6174 _ _ _ Project No. : - 10-676-01 <br /> Well Designation: <br /> ca <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES 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) : 91 <br /> Well cover type: 8" W 12" UV__,)Z_ 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <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: Disposal bailer: Teflon bailer: <br /> Well Diameter: 21' 4" 6" g!1 <br /> Purge Vol. Multiplier: 0.16 4. 65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge -Measurement <br /> . Time: � ) f Time: _ (4-. '13 Calculated purge: A' 6 <br /> Depth of well: d 6 Depth to water: 5 5.60 Actual purge: <br /> Depth to water: T J.6 6 (55- 56) <br /> Start purge:_ /6 Sampling time:— <br /> Time Temp. E.C. pH Turbidity Volume <br /> 0 71 - 1 .2- <br /> -72S <br /> 72SS 01 7. 6- <br /> 7L S <br /> 7. 5 f6 7 7- 6L 3 <br /> q .q o `72. 6 955 7, 50 <br /> L J <br /> Sample appearance: Lock: 1753 _ <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 /> .0 Remarks: <br /> Signature: <br />