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vI4tJUJ4 DOULOS <br /> PAGE e2 <br /> SAMPLING INFORMATION SHEET <br /> Cl�.ent <br /> _ ..._... .w�� sampling Date: <br /> �...� <br /> Site : SCJQ: <br /> Pro je ct No, <br /> - - well Designation:_: <br /> Is setup of tr ..-w f control devices required? YES time: hours <br /> Is there stancl:;)g water in well box? YES Above TOC� ow TOC <br /> Sel <br /> IS top of caslnq cut level? if no, see remarks <br /> Is well cap !-,er., led and locked? <br /> Height of we;._' easing riser (in inches) ; YES It no, see remarks <br /> Well cover type : g 1" UV ,T — - ---- <br /> 121r BK w . DWP t, UV �f 12" EMCO�� r/ BK <br /> 12 CNI 35 CNT Other Ivi <br /> General condit�on of wellhead assembly: Excellent Fair Poor <br /> Purging Equip?-;;__ : _211 disposable bailer � _Submersible pump <br /> _21' PVC bailer <br /> Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Samplea with ; Disposal bailer: Teflon bailer: <br /> We211 Da anetex: 2"-)—( Q"_ 6c" all <br /> Purge Vol . Multiplier: 0. 16 0. 65 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Rechar asu meet <br /> Time: ,.3—C ..� Time: 3 calculated purge:. <br /> Depth of we 1:L : __ { Depth to water' — -'-�� Actual purge <br /> Depth to water :_ "�'? <br /> Start purge: _ _ ID Sampling time: G1 <br /> Time ; Temp- E.C. pH Turbidity Volume <br /> 7, 16 <br /> Sample appearance: Lock: <br /> Equipment rep .a ezd: (Check all that apply) Note condition of replaced item <br /> 2" Locking c;ap :___ Lock #3753 : 7/32 Allenhead: <br /> 4" Locking cap: <br /> Lock-Dolphin: 9/16 Bolt: <br /> 611 wLocking c,an: Pinned Allenhead (DwP) <br /> Remarks: <br /> Signature: <br />