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�t .-L Y ✓ fi <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client 4!4, A t]2 S Sampling Date <br /> • Site Ra S' 1e�Z -aL ZSSo C t F 1�z� Project No <br /> J s2 5�!/ /�s�ro.rJ� S f: Well Designation _ 41 L✓ <br /> i . <br />, s <br /> Is setup of traffic control devices reguired9 YES time hours <br /> Is there standmg water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level? O If no,see remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing riser(m orches) <br /> Well cover type 8"or 12"UV 12"EMCOPr <br /> r 12"BK 2S, 8"Christy <br /> 12" Christy8"M&D 12"M&D WP <br /> 12"CNI 36"CM 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer 7t Submersible pump <br /> 2"PVC bailer Dedicated bailer <br /> 4"PVCbm-ler Centrifugal pump <br /> Sampled with Disposable bailer S Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> Initial Measurement Recharge easurement �y <br /> Time : yo Time r, 14g Calculated purge <br /> .Depth of well /o /. �J07 Depth to water '-(J - 'l Actual purge <br /> Depth to water Y9 $ <br /> Start purge 7 S 6 Sampling time �* <br /> I <br /> i <br /> Time Temperature EC pH Turbidity Volume <br /> l <br /> r� o /0 ly q61 7 x(43 <br /> P10 �, 3 <br /> Sample appearanceLock <br /> Equipment replaced (check all that applyl" Note condition of replaced item(s) <br /> 2" Locking Cap LocX# "oil Allenhead <br /> 4" Locking Cap Lock-Dolphin �`4 9/16 Bolt <br /> 6" Locking Cap Pinned AIlenhead (DWP) <br /> Oemarks t <br /> Signature <br /> !r" <br /> ' '� <br />