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n <br /> i <br /> � - , ..,.twr.r. .W.—N a..e«.-amara'-,• <br /> DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> Client Sampling Date ` 7r© <br /> Site e s Project No <br /> Well Designation w "� <br /> Is setup of traffic control devices required? 6RIT> YES tune hours <br /> Is there standing water nn the well box? gW YES Above TOG Below TOC <br /> Is top of casing cut lever NO o011D If no,see remarks <br /> Is well cap sealed and locked? NO If no, see remarks <br /> Height of well casing nser(u►inches) <br /> Well cover type 8"or 12"LV 12"EMCO 8"or 12"BK 8" Christy <br /> 12' Christy V M&D 12"M&D 12"DWP <br /> 12"CMI 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good_— Poor <br /> Purging Equipment 2"disposable bailer _ Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PV�bailer Centnfugal pump <br /> Sampled with Disposable bailer ^ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 9X <br /> Purge Vot Multiplier 0 16 6 65 147 2 61 gal/ft <br /> 1natial Measurement Recharge Measurement * <br /> Time Tune 10 :00 _ Calculated purge <br /> Depth of well 077. Depth to water _!;-q Actual purge <br /> Depth to water <br /> Start purge Sampling time /eq " <br /> I <br /> i <br /> i Time Tem erature E C pH Turbidit Volume <br /> -7T, *7 - 2 a Z <br /> Sample appearance Lock <br /> Equipment replaced (check all that apply .` Note condition of replaced item(s) <br /> 2' Locking Cap LOCK' V07/A Allemhead <br /> 4' Locking Cap Lock-Dolphin _ Ir 9116 Bolt <br /> 6' Y ocking Cap Pinned Allenhead(DWP) <br /> 1 <br /> Remarks <br /> Signature <br /> •d 002E 13rd3Sd-1 dH WdOb :6 0002 60 AdW <br />