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DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> z Client Sampling Date <br /> s . Site << Project No <br /> '; Well Designationw <br /> 70 �. <br /> h <br /> 'al <br /> Is setup of traffic control devices required9 YES time hours <br /> Is there standing water to the well boxy YES Above TOC Below TOC <br /> f <br /> Is top of casing cut level? O If no, see remarks <br /> Is well cap sealed and lockedf 1 NO If no, see remarks <br /> Height of well casing user(in inches) 11) <br /> Well cover type 8" or 12"UV 12" EMCO 8"or 12"BK 8"Christy <br /> 12" Christy8"M&D 12" M&D 12"DWP <br /> 12"CNI 36" CNI 12"Pomeco Other —T—'X 3 <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 Teflon bailer Disposable Tubing <br /> Well Diameter 2" DC 4" 6" g" <br /> Purge Vol Multiplier 0 16 065 1 47 2 61 gaUfl <br /> i Initial Measurement Recharge Measurement <br /> !Time % 3 7 Time 2 57 Calculated purge <br /> Depth of well 7' f s Depth to water 4 7 • Actual purge <br /> Depth to water - 7 eS <br /> Start purge '? .' /g Sampling time �= <br /> Time Temperature E C �H/y Turbidity Volume <br /> +�= 1 O ?O 0 <br /> let <br /> Sample appearance w.� _ Lock A.- /4— <br /> Equipment replaced (check all that apply` Note condition of replaced item(s) <br /> 2" Locking Cap LocR* '`!7/ Allenhead <br /> 4" Locking Cap Lock-Dolphin 4/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> i6emarks 1 <br /> Signature <br />