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3 <br />€, DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client �-��4 S"' Sampling Date <br /> • Site C s Project No <br /> a S 14: Well Designation <br /> is setup of traffic control devices required? YES time hours <br /> Is there standing water in the well box? 0YES Above TOC Below TOC <br />' Is top of casing cut level? NO If no,see remarks <br /> Is well cap sealed and locked? NO If no,see remarks <br /> Height of well casing nser(in inches) <br /> Well cover type 8" or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12 ' Christy 8"M&D= 12"M&D 12"DWP <br /> 12" CNl 36"CNI 12"Pomeco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer X- Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centnfugal pump <br /> Sampled with Disposable bailer _ Teflon bailer Disposable Tubing <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol Multiplier 016 065 147 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br />' Time G = 10 Time -7 tS f Calculated purge <br /> iDepth of well 1 O a Depth to water S f+ 03 Actual purge 2 <br /> Depth to water q j <br /> i <br /> Start purge 7 '3 6 Sampling time 7 =S <br /> Time Temperature E C pH Turbidity Volume <br /> /0 <br /> 2 2 <br /> d ' I' 7 XG ?- 93 3 <br /> Sample appearance �C.G� _ Lock <br /> Equipment replaced (check all that apply) Note condition of replaced item(s) <br /> 2" Locking Cap Lock, ''.'�� Allenhead <br /> 4" Locking Cap Lock-Dolphin � T 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DVWP) <br /> Oemarks fi <br /> Signature <br />