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DOULOS ENVIRON]JENTAL C07W,�NY '' �.,' SAM$LINO INFORMATION SHEET <br /> { <br /> ` Client• Sampling Date: �J 2•/o ' o <br /> 1� Site: Project No, : <br /> ' x$"600 R.ol Well Designation: w <br /> 4 <br /> 1 Is setup of traffic control devices required? Ng. time: hours <br /> Is there standing water in well box? NO Above TOC Below TOC <br /> Is top of casing out level? NO If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type : 811 UV 1211 W 12' EMCO 8 11 BK <br /> 12 " BK 1211 DWP 1211 CNI 3 611 CNI other, 11,ol 9(f 1.2 <br /> General condition of wellhead assembly: Excellent d Fair poor <br /> Purging Equipment: , ,211 disposable bailer Submersible pump <br /> 211 PVC bailer Dedicated bailer <br /> 411 PVC bailer ,Centrifugal pump <br /> I <br /> Sampled with: Disposable bailer:_.,tgL Teflon bailer: <br /> Well Diameter: 211ZI—e- 411 611 811 <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> 1 • <br /> Time: Times Z = Z Calculated purge: <br /> Depth of well : 2 0• Depth to water: -0a Actual purge : <br /> Depth to water: 19 <br />'T Start purge : X Z d Sampling time: 2 <br /> I <br /> Time Temp._. E.C. pH Turbidity Volume <br /> -2 : 753 -Z z b .6 b S <br /> Sample appearance: Lock: a1 <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 /> J <br /> Y <br /> Sig-nature : <br />