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Jib/829054 DQULOS, <br /> PAGE 86 <br /> SAMPl,INO <br /> Client INFORMATION SHEET <br /> i Sampling Data: f b <br /> Site ( - <br /> P Project No. : <br /> - - Well. Designation: o"I W -- <br /> Is setup af' traffic control devices required? <br /> Is there stand:enc water in well box? YES time: <br /> Is top of cas +,nq cut level? NO ° <br /> Is well cap sealed a Above TOC e ow fi0 <br /> and locked? NO If no, see remarks <br /> Height of wel.., caving riser NO if <br /> Well cover type: 11It <br /> no, see remarks <br /> (in inches) : <br /> 12 It „ DUV 12 10 UV 1211 <br /> �EMCO _ g ri $K <br /> General conditor, pf We�lheadr,assemb 3610 CNI.. er <br /> y: Excellent a Fair Poor <br /> Purging Equ1pme": 2ri disposable bailer <br /> - 2" PVC bailer Submersible pump <br /> �411 PVC bailer Dedicated bailer <br /> Centrifugal pump <br /> Sampled with . Disposal hailer:}� <br /> Teflon hailer: <br /> Well Diameter: 2"� rr <br /> 4 Err g„ <br /> Purge Vol . Multiplier: 0. 16 Y <br /> it ' al Measurement 0. 65 1.47 2 . 61 <br /> Time: T_ <br /> R-ec a asu eme t gal/ft. <br /> Depth of well : .k; Q Time: N- Calculated purge: r <br /> ter: - J` . 5 Depth to water: <br /> Depth to waD• <br /> Actual purger <br /> Start Purge:�C? _ <br /> Sampling time: <br /> if <br /> Temp. E.C. <br /> pHTurbidity volume <br /> �3 . c7 k1 6 .90 <br /> ? <br /> sample appearance: <br /> Lock: r"r R 5 7-AC--- <br /> Equipment replacQd : (check all that a <br /> 2" Locking Cap:__y pPly) Note condition of replaced item <br /> 4" hocking cap;_ Lock 83753 :_. 7/32 Allenhead: _ <br /> 6" g p•Locking ca Lock-Dolphin: 9/16 Bolt: - <br /> � Pinned Allenhead (DWP) ;� <br /> Remarks: <br /> Signature: <br />