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5 eyy�y�tid,rrt��r <br /> MR <br /> r <br /> DOULOS ENVIRONMENTAL,INC. SAMPLING INFORMATION SHEET <br /> i <br /> Client Sampling Date -cap- <br /> Site 2,a . <br /> cap-Site . /e 4 _4k' o C r Project No <br /> 1 <br /> z E2 ED rJ7L_ S J�: Well Designation <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water to the well box? <ff�V YES Above TOC Below TOC <br /> Is top of casing cut leveh NO QTE5 If no,see remarks <br /> is well cap sealed and locked9 NO If no, see remarks <br />` Height of well casing nser(m inches) S <br /> Well cover type 8" or 12" UV 12"EMCO 8"or 12"BK 8"Christy <br /> 12" Christy 8"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 x Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4"PVC bailer 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 Measurement <br /> Time p Time JO o _ Calculated purge -7 <br /> .Depth of well Cl S Depth to water 60 / tS Actual purge O <br /> Depth to water go <br /> Start purge _ -_ [ Sampling time /4 3 <br /> Time Temperature E C pH Turbidity Volume <br /> 767 - a <br /> Sample appearance 61(410r Lock At <br /> Equipment replaced (check all that apply} Note condition of replaced item(s) _ <br /> 2" Locking Cap Lock` "'.'7/ Allenhead <br /> 4" Locking Cap Lock-Dolphin --- 44�- 9116 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Oemarks <br /> Signature <br /> Ak�f <br /> - -- - - -- - i <br />