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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: ELI '7W <br /> site: &,& - 6 95 Project No. : q Zt- 5-81 <br /> goo S ;t, _ Well Designation: MW-,10 <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YE.r Above TOC Below TOC <br /> Is top of casing cut level? NO E If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" UV 1211 EMCO 811 BK <br /> 12" BK 12" DWP k 1211 CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent o 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:_X Teflon bailer: <br /> � - Fs>� gliPll ,IIPl�lef0lf <br /> Well Diameter: 21°-A- 4" 6" 84t <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> _Initial Measurement Rechar a Measurement <br /> Time: in z-S Time: _L1 Calculated purge• / 7 <br /> Depth of well: 4� fr6 Depth to dater:_ 7 3_ _ Actual purge: <br /> Depth to mater: 67.E <br /> Start purge: L0 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> c 1 11 q . 21 <br /> 2L 11 <br /> Sample appearance: _L&amn Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <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: <br />