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Vim.-" .. ,....w.acgr� — — pry .a,w+r r�'n^A.zr• <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client �J�14.4 frz .S _ Sampling Date J 'l© -eA <br /> Site R2,2 -2 /e -V/- Sa(f���-sem_ Project No <br /> 0 Well Designation w-' 6 <br /> 1 <br /> is setup of traffic control devices requued9 f0fg YES time hours <br /> Is there standing water to the well box? YES Above TOC Below TOC <br /> f Is top of casing cut leverT If no, see remarks <br /> Is well cap sealed and locked NO IKIf no,see remarks <br /> Height of well casing riser(ut inches) 'C <br /> Well cover type 8"or 12"W 12"EMCO _ 8"or 12"BK 8"Christy <br /> 12" Christy8"M&D 12" M&D 12"DWP <br /> 12" CNI 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Goode Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4" PV bailer -Centrifugal pump <br /> Sampled with Disposable bailer _ Teflon bailer Disposable Tubing_ <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gallft <br /> Initial Measurement Recharge Measurement / O <br /> Time Time 'IJ- purge Calculated <br /> i Depth of well meq' ' g Depth to water Actual purge <br /> Depth to water 7 3 <br /> x <br /> Start purge R : a® Sampling time <br /> Time Temperature E C H Turbidity Volume <br /> /D <br /> d 7 � 7 2 <br /> � •os /03 -7- YO 3 <br /> ' Sample appearance Lock <br /> Equipment replaced (check all that applyl' Note condition of replaced item(s) <br /> 2" Locking Cap Loch' "'NAllenhead <br /> 4" Locking Cap Lock.-Dolphin � A 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Oemarks t <br /> Signature <br /> �1, <br />