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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: qnr,,1L Sampling Date: 6 00 <br /> Site: a%.r� Project No. : <br /> 16Ld, Well Designation: M "'f <br /> _ CA <br /> s I... IY.IY I I I■ II ■I�� � I I <br /> Is setup of traffic control devices required? e 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 If no, see remarks <br /> Is well cap sealed and locked? N( S If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" W 12" UV 1.2" EMCO 8" BK <br /> 1211 BK 1211 DWP 12" CNI 3611 CNI Other t FM CC <br /> General condition of wellhead assembly: Excellent Fair Poor <br /> Purging Equipment: 211 disposable bailer 3< pump <br /> 2" PVC bailer Dedicated bailer <br /> 411 PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: 02 Teflon bailer: <br /> Well Diameter: 211 4" 691 8" <br /> Purge Vol. Multiplier: 0 . 16 0. 65 1 . 47 2 . 61 gal/ft. <br /> initial measurement Recharae Measurement <br /> Time: - O �-� Time; Calculated purge: I J <br /> Depth of well : Depth to water: 7 Actual purge : `7T <br /> Depth to water: <br /> r <br /> Start purge: 3 - 7i5 Sampling time: Y <br /> Time Temp. E. C. pH Turbidity Volume <br /> 1 I <br /> ' 3 .30 7� 7��.8 <br /> -3 7 . 2 I) y o 7 . 1 ,3 <br /> Sample appearance: r_4allrh�l Lock: M <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 21' Locking Cap: Lock 03753 : 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap; Pinned Allenhead (DWP) : <br /> Remarks - <br /> Signature : <br />