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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> f Client Sampling Date: 3��foj <br /> Site. . . _. -n e15 Project No. 9L�_" 6-75-01 <br /> �Q S Well Designation: /1AW- <br /> Is Fatup 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? I If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : 6 <br /> Well cover type: 811 UV 12" UV 12" EMCO 8n BK <br /> 12" BK 1211 DWP 1211 CNI 3610 CN I Other <br /> General condition of wellhead assembly: Exlen ce Good Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 210 PVC bailer Dedicated bailer <br /> 410 PVC bailer Cen�w)! fuga p <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 210 " _ 6" 8,1 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2. 61 gal/ft. <br /> Initial Measureme t Rechar a Measurement <br /> Time: I1-3 6 Time: 5 qK Calculated purge: 27 <br /> Depth of well: 7C,7Depth to water: GG 2- actual purge: a <br /> Depth to water:IL// <br /> Start purge: Sampling time: , [� <br /> Time Temp. E. C. pH Turbidity Volume <br /> 7, z- i Lt ) <br /> 07 <br /> 12-3 1 <br /> 7e7� <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 200 Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 410 Locking Cap: Lock.-Dolphin: 9/16 Bolt: <br /> 6B0 Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: 42 <br />