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DOULOS BNVIROINAWAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: ]6 -2_1Z1LJ ' <br /> { Site: Project No. : 74t ta- <br /> ' Well Designation: W �- <br /> I <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? S Above TOC Below TOC <br /> Is top of casing cut level? N If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser (in inches) : A_6 <br /> Well cover type: 8" W 12" W 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI then <br /> General condition of wellhead assembly: Excellent o d Fair Poor <br /> 1 <br /> Purging Equipment: 211 disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer -A Centrifugal pump E <br /> Sampled with: Disposal bailer: Teflon bailer: <br /> Well Diameter: 2" 4" 61+ 8 t <br /> Purge Vol. Multiplier: 0. 16 0. 65 <br /> ---��� 1. 47 2 . 61 gal/ft. <br /> Initial Measurement Recharge Measurement <br /> Time: icy Timer _ _ Calculated purge: 3�. J ,► <br /> Depth of well: X5.7 Depth to water: 7 v Actual purge: <br /> Depth to water: 6. cf <br /> Start purge: Sampling time: 60!5 <br /> Time Temp. E.C. pH Turbidity Volume:- <br /> 3,7 65 <br /> r 6 7z 7 /1 ---- z <br /> Sample appearance: Ae3 Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock 13753: 7/32 Allenhead: <br /> 4" Locking Cap: Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> Signature: __ J <br /> 1 <br />