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DOULOS ENVIRONMENTAL .-3XPANY <br /> SAM NG INFORMATION SHEET <br /> 67 <br /> Client: U1 trangir - <br /> Sampling Date: <br /> Site; Beago 1412 Project No. : 94-419=91- <br /> -.-235Q Waterloo Road _� Well Designation: <br /> gtockton, C <br /> _ hours <br /> is setup of traffic control devices required? (a YES tirogy e'TOC Below TOC <br /> Xs there standing water in well box? NOIf no, see remarks <br /> Is top of casing cut level? NO E If no, see remarks <br /> Is well cap sealed an <br /> Height of well casing riser (in1 Mc e) : 12 EMCo�� g+� BK__ <br /> Well cover type 8" Wim_,. n CNI ^ 36" CNI__� Other �l° <br /> 12" BKS 12 DWP____�_,., Excellent Fair poor <br /> General condition of wellhead assembly: <br /> 2" disposable bailer _Submersible pump <br /> purging Equipment: Dedicated bailer <br /> 2„ PVC bailer <br /> 4” PVC bailer Centrifugal pump <br /> — <br /> Sampled with: Disposable bailer: <br /> Teflon bailer: <br /> Well Diameter: 2" 4 <br /> aI . ft'l0.65 1.47 2. 61 qal/ft. <br /> ge Vol. Multiplier: 0. 16 Rpr�harce Meas 1�'ement <br /> su 7 Calculated !urge: <br /> Time: }- Time: 4tu,Depth of well: 6 3 Depth to water: � k7' Actual purge: � <br /> Depth to water, y C <br /> Start purge: 7 Sampling time: <br /> Time Temp. <br /> E.C. pH Turbidity Volume <br /> 1,, <br /> -131 <br /> L_� A <br /> Sample appearance: Lock: <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Lock 13753 :�� 7/32 Allenhead:--- <br /> g Ca p•�� Lock-Dolphin: 9/16 Bolt: <br /> 4" Locking Cap: pinned Allenhead (DWP) :�� <br /> " Locking Cap: <br /> Remarks: <br />?Signature: <br />