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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> f <br /> Client• Sampling Date: <br /> Site- E3 Project No <br /> /j/ Well Designation. Mw- <br /> - `- .,c7i <br /> Is setup of traffic control devices required YES time; hours <br /> Is there standing water in well box'' V ES Above TOC Below TOC <br /> Is top of casing cut levels NO If no, see remarks <br /> Is well cap sealed and locked> NO If no, see remarks <br /> Height of well casing riser (in inches) : 21 <br /> Well cover type 8" UV 12" UV 12" EMCO 8t1 BK <br /> 1.2 " BK 12" DWP 12" CNI 36" CNI Other1�)--�M4} <br /> General condition of wellhead assembly: Excellent _rot'144 Fair Poor <br /> Purging Equipment: 2" disposable bailer � 4Submersible pump <br /> 21' PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with. Disposal bailer: Teflon bailer - -2- / <br /> Well Diameter 2" 4" 6" 8" <br /> Purge Vol . Multiplier. 0 16 0 . 65 1. 47 2 . 61 gal/ft . <br /> Initial Measurement Rechar e Measurement <br /> Time _ / .i7 Time: 77 M7 Calculated purge �,� <br /> *Depth of well. Depth to water: Actual purge; 5 �> <br /> Depth to water. x_14.1 D <br /> Start purge: 7 Sampling time; <br /> Time Temp. E. C. pH Turbidity Volume <br /> I7 _73 J 1 <br /> 1 <br /> 7472 U ��� -2- <br /> Sample appearance- ��, � Lock, 4- <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 /> 40 Remarks <br /> Signature - <br />