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1j�vG� UU:02 9167829054 DOULOS <br /> PAGE 07 <br /> SAMPLING INFORMATION SHEET <br /> client: <br /> Sampling Date: - `J - od <br /> own <br /> ,"W, v Project No. ; <br /> Well. Designabion:_&L�L- 6 <br /> Is <br /> setup o traffic control devices re <br /> Is there standing water in well box?required? YES time:-- <br /> YEShours <br /> Is top of casing cut level? Above TOC Below TOC <br /> Is well cap sealed and lacked? O If no, see remarks <br /> Height of wet= _-.asin riser No If no, see remarks <br /> Well cove) g (in inches) : <br /> LW <br /> �EMCO 8 " HK <br /> Gene1211 rl <br /> al conditio" of w heads"assembl ' 36" CNI ~,—�- <br /> Other <br /> Y• Excellent oo Fair Poor <br /> Purging Equipmcn _2" disposable bailer <br /> _ . 21' PVC bailer Submersible pump <br /> --.4" PVC bailer12 <br /> Dedicated bailer <br /> Centrifugal pump <br /> Sampled With: Disposal bailer: <br /> Teflon bailer: <br /> W4 311. Diameter; 2" ;& 411 <br /> 61, 81f <br /> Purge Vol . Mult;plier: 0. 16 <br /> iti l Measurement 0. 65 1, 47 2 . 61 gal/ft. <br /> Time: Recha reye Me sure-- ,�j <br /> Depth of well: �1 // `Time: D : 4 Calculated purge: d 6 <br /> Depth to wate,r.....-4;x%7 . <br /> Depth to water.• q 1. O 6 Actual purge:� <br /> Start purge : f C> <br /> - sampling time:-/O49 q <br /> Time Temp. E.C. PSI Turbidity Volume <br /> Sample appearance: <br /> Lock. <br /> Equipment replaceci : (Check all that 1 <br /> 2" Locking Cap: w- apply)Y) Note condition of replaced item <br /> 41" Locking cad: Lock i3753 :� 7/32 Allenhead•_ <br /> 6" Locking cap: <br /> Lock-Dolphin:_ 9/16 Bolt: w <br /> Remarks: Pinned AX lenhedd ( )DWP : <br /> Signature. <br />