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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client: Sampling Date: <br /> Site • _2-1 Fv Pro3ect No. • r <br /> AI Well Designation: MW- 1 <br /> Is setup of traffic control devices required' YES time: hours <br /> Is there standing water in well box'' YES Above TOC Below TOC <br /> Is top of casing cut level? IV JT�) If no, see remarks <br /> Is well cap sealed and locked NO gin✓ If no, see remarks <br /> Height of well casing riser (in inches) : 4/ <br /> Well cover type 8" W 12" W 12" EMCO 8" BK <br /> 12" BY 1211 DWP 1211 CNI 3611 CNI Otherll /%+O <br /> General condition of wellhead assembly: Excellent � 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: Disposal bailer: Teflon bailer: .GF�- <br /> Well Diameter: 2" 411„k— 6" 8" <br /> Purge vol Multiplier: 0 . 16 0 . 65 1. 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement r� <br /> Time Time 166 Calculated purge: /s, <br /> Depth of well .3 Depth to water. 7�1- Actual purge . 7F, 4 1i <br /> Depth to water !j,/3 <br /> Start purge- 163!3 Sampling time: T <br /> Time Temp. E C. pH Turbidity Volume <br /> 16 <br /> Sample appearance- _Wa,^ Lock: d <br /> Equipment replaced : (Check all that apply) Note condition of replaced item <br /> 2 " Locking Cap- Lock #3753 • 7/32 Allenhead: <br /> 4 " Locking Cap. Lock-Dolphin: 9/16 Bolt: <br /> 6" Locking Cap. Pinned Allenhead (DWP) : <br /> Remarks <br /> Signature - <br />