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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> � Y L <br /> Client: F. Sampling Date• 6-)-Z` 'C70 <br /> Site . _ - 1 Project No. : <br /> &Well Designation: MW-C�' <br /> �7 <br /> Is setup of traffic control devices required YES time- hours <br /> Is there standing water in well boxy KJO YES Above TOC Below TOC <br /> Is top of casing cut level? NO If no, see remarks <br /> Is well cap sealed and locked") NP, if no, see remarks <br /> Height of well casing riser ( in inches) : <br /> Well cover type 8" UV 12" UV 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI then <br /> General condition of wellhead assembly Excellent CooFair 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: _3!�_ <br /> Well Diameter* 2" 4F' 6" 8" <br /> Purge Vol . Multiplier: 0 . 16 0 . 65 1 47 2 . 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time. 161-3 Time• 17 2:c Calculated purge <br /> Kepth of well Depth to water Actual purge <br /> epth to water. <br /> Start purge: 6 Sampling time: <br /> Time Temp. E. C. pH Turbidity Volume <br /> l711 � l <br /> Sample appearance: Lock. <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 /> f <br /> Signature <br />