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DOOLOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:_ Sampling Date: <br /> Site: .. 6A. _._I; Project No. : qlf--610 <br /> q �0 5 ��►„Pf=d% Well Designation: kw' 1 _T <br /> CIA, <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? O YES Xbove TOC Below TOC <br /> Is top of casing cut level? NO `-� if no, see remarks <br /> Is well cap sealed and locked? NOxf no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 811 W 12” UV1211 EMCO 819 BK <br /> 12" BK 1299 DWP 12" CNI 36" Other <br /> General condition of wellhead assembly: xcellen Good Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 4t1 PVC bailer Centrifu al pump <br /> D <br /> Sampled with: Disposal bailer:- Teflon bailer: <br /> Well Diameter: 211 419 610 811 <br /> Purge Vol. Multiplier: 0. 16 0.65 1.47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measureme <br /> Time: /1 ,L) Time: 313 ._„ Calculated purge: �� <br /> Depth of well:_s q Depth to dater: C. Actual purge: <br /> Depth to water: bG,��_ _ <br /> Start purges 33 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> f", C Li I- 11-1 1 <br /> 3w, 623 ko r a <br /> 450 66Z 3 <br /> g� D C-2-77. 3.2. <br /> Sample appearance: _� Lock: C �-- .�• <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2f9 Locking Cap: Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: _ 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />