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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client Sampling Date:--- ZZ 'DD <br /> SiteProD ect No <br /> 0 _ Well Designation TMW- f <br /> Gro , <br /> Is setup of traffic control devices required O YES tine* hours <br /> Is there standing water in well box" 2 YES Above TOC Below TOC <br /> Is top of casing cut level',, NO 17D If no, see remarks <br /> Is well cap sealed and locked") NO )�D If no, see remarks <br /> Height of well casing riser (in inches) : —+ g <br /> Well cover type 8" UV 12" UV _ 12" EMCO 8" BK <br /> 12 " BK 12" DWP "k- � 1211 CNI 36" CNI Other <br /> General condition <br /> ,.of wellheaddembl�, Excellent oo Fair Poor <br /> Purging Equipment 21' disposable bailer Submersible pump <br /> 2" PVC bailer `�/A! Dedicated bailer <br /> 4" PVC bailer /L Centrifugal pump <br /> Sampled with Disposal bailer _ Teflon bailer. <br /> Well Diameter • 2" 4 1' K— 611 811 <br /> Purge Vol Multiplier 0 . 16 0. 65 1. 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time 11)-14 Time. 1 /4 Calculated purge: 6.Z- <br /> Depth of well : ar L,07 Depth to water-, -a,� !f Actual purge <br /> epth to water: s g <br /> Start purge 11445 Sampling time: 1 <br /> Time I Temp. E. C. pH Turbidity Volume <br /> 11 z /7 z6 71 j <br /> 1 Loam z <br /> 6's <br /> J )- o / 6,5 2- 14-6 <br /> Sample appearance . Lock: •? <br /> Equipment replaced - (Check all that apply) Note condition of replaced item <br /> 2 Locking Cap; Lock 03753 • 7/32 Allenhead <br /> 4 " Locking Cap. Lock-Dolphin- 9/16 Bolt . <br /> 6" Locking Cap• Pinned Allenhead (DWP) <br /> Remarks <br /> C <br /> Signature <br />