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raMrcPq�'+car�f� - <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> l, <br /> Client Sampling Date d <br /> Site C r s- Project No <br /> o S / Well Designation r i W' y <br /> Is setup of traffic control devices required? YES time hours <br /> Is there standing water m the well boxy YES Above TOC Below TOC <br /> Is top of casing cut lever NO If no, see remarks <br /> Is well cap sealed and locked9 NO If no,see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8" or 12"UV 12" E CO 8"or 12"BK 8"Christy- <br /> 12" <br /> hristyl2" Christy8"M&D 12"M&D_ 12"DWP <br /> 12" CNI 36"CM 12"Pomeeo Other <br /> General condition of wellhead assembly Excellent Goad Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 016 065 1 47 2 61 gaUft <br /> Initial Measurement Recharge Measurement <br /> Time -7 ', O 1 _ Time e , 3 '? Calculated purge <br /> .Depth of well G 7 _ Lf S Depth to water !;0 . 16 Actual purge _ (� <br /> ` Depth to water <br /> Start purge 13 ' 3 4 Sampling time <br /> Time Temperature EC pH Turbidi Volume <br /> 8 3 2 6 9 .,6 q •06 <br /> Sample appearance Lock <br /> Equipment replaced (check all that applyY Note condition of replaced item(s) <br /> 2" Lacking Cap LocX,,, '`'7/ Allenhead <br /> 4" Locking Cap Lock-Dolphin44 9116 Bolt <br /> 6" Locking Cap Pinned Allerihead (DWP) <br /> Oemarks t <br /> Signature <br />