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j"Lrjna nts:el 9167829654 DOULOS <br /> PAGE 65 <br /> SAMPLING INFORMATION SHEET <br /> ' Client <br /> site ----- ��, Sampling Date: <br /> Project No. : <br /> We 11 Designation: <br /> Is setup of trafAic control devices required? YES _ <br /> Is there standing water in well box. time: <br /> rs <br /> Is t° � Y Above TOC �Below uTo <br /> Is well cap asealeduand elocked? C <br /> NO If no, see remarks <br /> Height cover <br /> we,-. -riser (in inches NO E If no, see remarks <br /> Well cover type: 8'+ iN ++ ) .� <br /> 2" BK 11 --._ N UV 12" EMCO <br /> General condition DOfw�head+►assembl 6e+ CNI <br /> er <br /> Y. Excellent p Fair Poor <br /> Purging EquipmNn- : ��2++ dzspdsable bailer <br /> 2" PVC bailer , `Submersible pump <br /> -_41' pvC bailer Dedicated bailer <br /> ��-Centrifugal pump <br /> Sampled with: Disposal bailer: <br /> Teflon bailer: <br /> Well Diameter: 2f' 4" <br /> Purge Vol . Multiplier: 0. 16 <br /> itis Measurement 0. 55 1. 47 2 . 61 gal/ft. <br /> Time: S echo s eme <br /> Depth of well : Time:__LL-L- Calculated purge: <br /> Depth to water-- q . O ]Depth to water: Actual purge: <br /> te.. <br /> Start Purge: <br /> Sampling time: �l <br /> Time Temp' B. C. PN Turbidity Volume <br /> l " o i - : 6 �f3 I <br /> 7 - 06 <br /> --� <br /> Sample appearance: � <br /> Lock: <br /> Equipment replacecl: (check all tha <br /> 2" Locking Cap:... t apply) Noce condition of replaced item <br /> . Lock #3753 : <br /> 41+ Locking cap::-- Lock-Dolphin:- 7/32 Allenhead: <br /> 6" Locking Cap:-- 9/16 Bolt:"- <br /> Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: <br />