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DOULOS MMXRONDlMTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: [) 14r a W a Y Sampling Date: R <br /> Site:-7p, 0 SR 601 Project No. : - b 0 <br /> —w-ge-51 Kekw,,Ln r weli.. Designation: `VV <br /> Is setup of traffic control devices required> YES time: hours <br /> Is there standing water in well box? 4 YES Above TOC Below TOC <br /> Is top of casing cut level? NO S If no, see remarks <br /> Is well cap sealed and locked? NO fn If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <2 " c-Nzo , <br /> General condition of wellhead assembly: Excellent dooJ 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"_y__�' 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 .61 gal/ft. <br /> 'tial Measurement Recharge-Measurement <br /> eime: Time: I ' 10 s, g-3 Calculated purge: to 1 � a <br /> epth of well: 5 7 Depth to water: Actual purge: <br /> Depth to water: q M <br /> Start purge: 12- 11 -50 Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> 12 '155_ 6__6 , 3-K'11 __7- <br /> 001 <br /> 1I <br /> r 0 0. - �_ �g 0 /L _7. <br /> l : 03 - 1, 7 q 5 W7.5 <br /> ,� g� , 2 3 `7 , � <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item _-r _ <br /> 2" Locking Cap: Lock 13753: 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: - 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: `{ <br /> Signature: AV- <br />