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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: qnfg�� __ Sampling Date: 6 "�_ C~ <br /> Site : Project No. : <br /> f 61 Well Designation: <br /> CA <br /> i <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? � Y S 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) : q <br /> Well cover type: 8 i W 12" W 1211 EMCO 8" BK <br /> 1211 BK 1211 DWP 1211 CNI 3611 CNI Other. l2 A-1) <br /> General condition of wellhead assembly: Excellent <2� Fair Poor <br /> Purging Equipment: 211 disposable bailer _Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: SP Teflon bailer: <br /> Well Diameter: 211 4" 611 891 <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> ? � Initial Measurement Re ha ge Kegsuremen& <br /> 3 <br /> f Time: Time : = Calculated purge: <br /> Depth of well , 63-01 Depth to water: Actual purge: <br /> Depth to water: <br /> - LLIE <br /> sStart purge:3 � 20Sampling time: �- <br /> s <br /> Time Temp. E. C. pH Turbidity Volume <br />, <br /> i <br /> 3 !�� 24 © 7� 2 <br /> Sample appearance: Lock: <br /> �rr1�4Y1r_�Illrir`�rrr.Pl .' .r.rrrnr irnu .nn rr <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 /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks : <br /> Signature - <br />