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DOULOS SMVIROZMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site: +- W Project No. 147 <br /> 47� -D I <br /> I <br /> 3 L4D E •AL& Well Designation:_ h! .•„_ k <br /> Gam, <br /> AA I IAIrA. I�.Ilil <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? X <br /> M Above TOC Below.. TOC <br /> Is top of casing cut level? I Ifflod If no, see remarks <br /> Is well cap sealed and locked? NO IRV If no, see remarks <br /> a. Height of well casing riser (in inches � <br />{ Well cover type: 8” UV 12" UV L1' 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI her <br /> General condition of wellhead assembly: Excellent 13,00q Fair Poor <br /> 111.1 AIr11�IIlAI . r <br /> i <br /> I I <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer : <br /> 4" PVC bailer x�Centrifugal pump.' <br /> yIy Sampled with: Disposal bailer: Teflon bailer: ' <br /> 1 11.114AIP.. III <br /> 11 ..11111 Ir..AIIPIIIIPUIIaI..I.� <br /> a Well Diameter: 2" 4"4— 6" 8" <br /> E <br /> Purge Vol. Multiplier: 0.16 0.65 1.47 2.61 gal/ft. <br /> E Initial Measurement Recharge Measurement <br /> Time: 6z-7 Time: 7)S Calculated purge: L <br /> Depth of well: Depth to water: Actual purge• 3L <br /> Depth to water: 9 <br /> Start purge: 6 D Sampling time: <br /> l <br /> Time Temp. E.C. pH Turbidity Volume <br /> S 5 -7e,,6 I= 766 <br /> 3 <br /> 1 /v 7[ 3-6 <br /> Sample appearance: 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 /> f <br /> Remarks: <br />