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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> .y. <br /> Client: Sampling Date: 3-JJ-7 U <br /> Site: L&aZ&AM Project No. : ..601 <br /> Well Designation: Al w <br /> Is setup of traffic control devices required? NO YES time: hours <br /> Is there standing hater in well box? NO YES Above TOC Below TOC <br /> Is top of casing cut level? NO YES If no, see remarks <br /> Is well cap sealed and locked? NO YES If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 UV1211 UV 12" EMCO 891 BK <br /> 1211 BK 1211 DWP 1219 CNI 3611 CNI Other <br /> General condition of wellhead assembly: Excellent Good Fair Poor <br /> Purging Equipments 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer —Centtrifyuggaal_. pump <br /> Sampled with: Disposal bailer: Teflon b'ailer: <br /> v ■IL�>l.31. II�.SI <br /> Well Diameter: 201 �P9�_ 691 $11 <br /> Purge Vol. Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge_Measurement <br /> Time:__- nO - _ Time: tj)j9 Calculated purge: O2 <br /> g <br /> Depth of well: lir Depth to hater: Actual purge: 3 6�.� <br /> Depth to water: �5 <br /> Start purge: ~ X23 D Sampling time: �:/ h <br /> Time Temp. E.C. pH Turbidity Volume <br /> 1�L 3,5 <br /> 1 x.14 Z G 7, q 3 8 <br /> Its <br /> 9' <br /> 0-40 6 ---- 21 <br /> - <br /> Sample appearance: �. _ Lock: <br /> P I <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 200 Locking Cap: Lock #3753: 7/32 Allenhead: <br /> 411 Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 611 Locking Cap: Pinned Allenhead (DWP) : <br /> Ilk <br /> Remarks: <br /> Signature <br />