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i <br /> • DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: °�.C.� � Sampling Date: I LI <br /> Site: C-1=j C-1Protect No. °_ 4114 -61 01 <br /> yD4 S _ -. a Well Designation: 14UV-.)_S <br /> Is setup of traffic control devices required? IN <br /> YES time: hours <br /> Is there standing water in well box? ES Above TOC Below TOC <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : kt <br /> Well cover type: 819 W 1219 UV 1211 EMCO 8 99 BK <br /> 12" BK 1219 DWP•11�=T2" CNI 3690 CNI - <br /> ther <br /> o <br /> General condition of wellhead assembly: Excellent oFair Poor <br /> Purging Equipment: �99 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 419 PVC bailer Centrifugal pump <br /> Sampled with: Disposal bailer:_ Teflon bailer: <br /> Well Diameter: 200 499 6" 89v <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge- Measurement <br /> Time: Time: I1x1�& Calculated purge: 1.6 <br /> Depth of well: CJ Depth to water: o b Actual purge: <br /> — <br /> Depth to water:_ 1 <br /> Start purge: 3 3 Sampling time: 3 C� <br /> Time Temp. E.C. pH Turbidity Volume <br /> ' 6 � 1c�� 3 <br /> 7, 7 — <br /> 3 1A10 6 7. 7 _71 <br /> Ll <br /> Sample appearance: j aeu= Lock: 3 <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 /> 6t0 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />