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I S <br /> DOULOS ENVIRQN=XTAL COKPAn - SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: s _ 1 �.�_3? <br /> Site: Project No. ; <br />` <br /> PAM/un Well Designation: 5 VV r <br /> Z- �� ��Q,, G A <br /> Is setup of traffic control devices required?� YES time: hours <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked? NO/ E If no, see remarks <br /> Height of well casing riser (in inches) ': <br /> Well cover type: 8" UV12" W 12" EMCO 81" SK <br /> 12" BK 12" DWP 1211 CHI 36" CNI Other /'.,1 G <br /> General condition of wellhead assembly; Excellent eeC70 Fair Poor <br /> Purging Equipment: 21' disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 41' PVC bailer Centrifugal pump <br /> Sampled with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1. 47 2 , 61 gal/ft. <br /> Initial Measurement Bechar e Measurement <br /> I Time: Time: LL- 2 O Calculated purger' <br /> Depth of well : 3 Depth to water: a Actual purge; ,5 <br /> Depth to water: <br /> start purge: / - z- Sampling time: <br /> Time Temp... E.C. pH Turbidity Volume <br /> o o 7 / r— <br /> ll= yr 1 7 � 7. 7 f <br />' ll - -7 1 161- T7 <br /> Sample appearance: Lock: _ <br /> 61 <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 211 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 />