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1 i y A r jl + !*fih '•.p�Ja4tArnil' _ � v i r J'�rp,>t{yf r ���' ri <br /> DOULOS ENVIRONXENTAZ aoNFMY SA"LING INFORMATION SHEET <br /> ' , <br /> Client : Sampling Date: ��4"p z- <br /> 1 site: Zaa 644.1, Project No • <br /> / <br /> 6'600 L2�=1an Ra! Well Designation; M W15, t <br /> 4 <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? 91 YX S Above TOC Below TOC <br /> Is top of casing cut level? NO e7ST& If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) � 4z <br /> Well cover type: 8" UV12" UV- 12" EMCO " BK <br /> 1 12 " BK 12" DWP 12" CHI 36" CNI Otherd-eUCL7�:_ <br /> General condition of wellhead assembly; Excellent o d Fair Poor <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> 1 <br /> Sampled_ with: Disposable bailer: Teflon bailer: <br /> Well Diameter: 21 611 <br /> I_ 811 . ..__.,. <br /> r <br /> 1 • Purge Vol. . Multiplier: 0 . 16 0. 65 1, 47 2 . 61 gal/ft. <br /> 101tir, l tleasurement ReRbgXae Measurement <br /> Time: n-5 G _ Time; - 7 Calculated purge: <br /> Depth of well : -z'9.Oi Depth to Water: - 6-< Actual purger <br /> Depth to water: Z Q <br /> T Start purge : _ /O Sampling time: U."Efs <br /> r Time Temp-. E. C. pH Turbidity Volume r <br /> //•'v/ �9 1 �osr <br /> i <br /> Sample appearance; Lock: ""Ve Ci <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap: Lock J037RI_ 7/32 Allenhead: <br /> 4 " Locking Cap; Lock-Dolphin;_ _ _ 9/16 Bolt; <br /> 6" Locking Cap: P%nned A41enhead (DWP <br /> Remarks : <br /> i <br /> Signature : <br />