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,� � FSyyRypnr�r i^w <br />} <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client Sampling Date S d <br /> . Site as S �� vL 5d C(9z' <br /> 9 ?L-Q Project No <br /> 7� <)7) ��•,o,r/f 5 7L Well Designation <br /> Is setup of traffic control devices required9 gqR17 YES time hours <br /> Is there standing water in the well boxy YES Above TOC Below TOC <br /> Is top of casing cut levels wa If no,see remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing riser(iii inches) � <br /> Well cover type 8" or 12"LTV 12"EMCO !C.9or 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 Good_ Fair Poor <br /> Purging Equipment 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4"PVC bailer _X-Centrifugal pump <br /> Sampled with Disposable bailer. X Teflon bailer Disposable Tubing <br /> f Well Diameter 2" >-!�- 4" 6" 8" <br /> f <br /> Purge Vol Multiplier 0 16 065 147 2 61 gal/ft <br /> Lnitial Measurement Recharge Measurement <br /> Time ' 1 O Time 10:9 _ 0 SS Calculated purge e7 <br /> .Depth of well 1 O 3 Depth to water S 2 30 Actual purge -30 , 0 <br /> Depth to water Lf 460. <br /> Start purge 2 Sampling time �O 4 <br /> 3 Time Terri era=e EC pH Turbidi Volume <br /> � a � <br /> / oo <br /> D O gal 44"*- 9 0 •� <br /> Sample appearance Lock <br /> Equipment replaced (check all that apply$'` Note condition of replaced item(s) _ <br /> 2" Locking Cap LocR,, X1444 nhead <br /> 4" Locking Cap Lock-Dolphin 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWT) <br /> Oemarks t <br /> Signature , <br />