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DOULOS ENVIRONMENTAL, INC SAMPLING INFORMATION SHEET <br /> Client 9=2fn Sampling Date — I -` O <br /> Site JC�e' cw,.,/► Project No <br /> 2,06'0 Well Designation M ilii <br /> .�. G A - - <br /> is setup of traffic control devices required YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut lever NO � If no, see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8" or 12"W 12" EMCO�X 8"or 12"BK 8"Christy <br /> 12 Chrisry 8" M&D 12"M&D 12"DWP <br /> 12" CNI 36" CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent GoodNo'� Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer X Centnfugal pump <br /> Sampled with Disposable bailer X Teflon bailer Disposable Tubmg <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/fl <br /> i Initial Measurement Recharge Measurement <br /> Time = L( 6 p Time / D: / Calculated purge 0 ' <br /> ;j Depth of well dO •�o Depth to water - 7 Actual purge O <br /> Depth to water 9 -7 -73.1 <br /> i� <br /> Start purge a = S 0 Sampling time rf <br /> Time Temperature E C pH Turbidity_ Volume <br /> a � I 2 - '�- 1 gal � • � G � <br /> •. S3 2 . 3 1 � � 3 � •�v 2 <br /> It I - - <br /> Sample appearance Lock 't'- <br /> Equipment <br /> 'VEquipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock 7132 Allenhead <br /> 4" Locking Cap Lock-Dolphin 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> s <br /> t •Remarks <br /> yyS <br /> i$ <br /> S <br /> }'t <br /> Signature <br /> i <br />