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• «�� r�o:ar yJlbr829059 DOULOS <br /> PAGE 03 <br /> SAMPLING INFORMATION SHEET <br /> Client , _ _ <br /> SiteSQ Sampling Date:�7_ ©C? <br /> 1� o Project No. : <br /> Well Designation: All w ` <br /> Is setup of t-af# ic control devices required? <br /> Is there standinc water in well box?Is time: <br /> Is top of cas i.r�g Cut level? hours <br /> Is well cap se.� Led and lacked? Yr,�•, Above TOC Below TOC <br /> � �✓ If no, see remarks <br /> Height of wet <br /> -acing riser (in itJVncheS) YES <br /> Well cover type : g 11 If not see remarks <br /> �{ <br /> 1211 BK "� -� 12 UV__ 12 a� MCO g�� BK <br /> Genera?condition�of w�eadff ass embi CNI36n CNI_,_ Other <br /> �--� <br /> Y� xcellent Fair. Poor <br /> Purging Equipr,er„W : _2i, disposable bailer <br /> x_,.,.211 PVC bailer `Submersible pump <br /> �4” PVC bailer --.Dedicated bailer <br /> r , Centrifugal pump <br /> Sampled with: DiSPosal bailer:_ <br /> Teflon bailer: <br /> Well Diameter: 211� 4" — <br /> 6" g it <br /> Purge vol . Multiplier: 0. 16 <br /> n t 'al Mea urement x. 65 1. 47 2. 61 gal/ft. <br /> Time: _ cha e M ure ent <br /> Depth of .well .. <, �.� �� Time: ' <br /> Depth to water : Depth to water: 3�1` Calculated purge: <br /> 1 d Actual purge- <br /> Sampling <br /> Start purge:��� <br /> -- Sampling tame: <br /> Time j Temp. E.C. <br /> PH Turbidity Volume <br /> Iz <br /> 3 .�. 0 <br /> I <br /> Sample appearance: <br /> Lock: No rV <br /> Equipment replacec3 : (Check all that apply) <br /> 2" Locking cap. .-_ PIS Y) Not conditinzl of replaced item <br /> 4" Locking Cap; _ Lock #3753 : 7/32 Allenhead: <br /> 4" Locking Cap:__ Lock-Dolphin: <br /> Pinned Allenhead6 �T <br /> (DwP) : <br /> Remarks: <br /> Signature: <br />