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-�'- .�.. - -- xrfwnu�• wvarorsryysi'D'rsvas i^ <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client �,� Sampling Date S,t'© ` OA- <br /> 4/ — — - <br /> . Site Project No <br /> tS-a e��o S 7�: Well Designation W — D <br /> f / <br /> F <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water in the well boxy YES Above TOC Below TOC <br /> Is top of casing cut levels go OM5> If no,see remarks <br /> Is well cap sealed and locked' _ NO If no,see remarks <br /> Height of well casing riser(in inches) <br /> Well cover type 8" or 12"W 12"EMCO 8" or 12"BK 8" Christy <br /> l2" Chrisry8" M&D 12"M&D 12"DWP <br /> 12" CNI 36" CNI 12"Pomec�_ 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 / Centrifugal pump <br /> Sampled with Disposable bailer P Teflon bailer — Disposable Tubing <br /> Well Diameter 2" 4" 6" g" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gal/ft <br /> r' Initial Measurement Recharge Measurement 1 r <br /> Time -? o ? Time S Calculated purge <br /> .Depth of well 1 ' o y Depth to water O O Actual purge r <br /> Depth to water © 3 <br /> i <br /> Start purge = Sampling time 3 <br /> Time Temperature E C RH Turbidity Volume <br /> i 70 '0 <br /> 0 0 `� G 7• L6 3 <br /> Sample appearanceLock J <br /> Equipment replaced (check all that apply$' Note condition of replaced item(s) <br /> 2" Locking Cap LocR* "W4Allenhead <br /> 4" Locking Cap Lock-Dolphin ,4 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Oemarks <br /> Signature <br /> �1 <br />