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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client Sampling Date: <br /> Site - _ ProDect No <br /> • well Designation. Mw- <br /> Is setup of traffic control devices required" YES time hours <br /> Is there standing water in well box'? O YES Above TOC Below TOC <br /> Is top of casing cut level's NO 11ZD If no, see remarks <br /> Is well cap sealed and locked> NO 4�D If no, see remarks <br /> Height of well casing riser (in inches) : <br /> well cover type 8" UV 12" UV 12" EMCO )r" _ 8" BK <br /> 12 " BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly Excellent oo 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- <br /> Well Diameter- 2" 4" 6" 8" <br /> Purge Vol Multiplier. D 16 0 . 65 1. . 47 2 61 gal/ft <br /> Initial Measurement Recharge Measurement <br /> Time l Z Time _ x--17 _ Calculated purge <br /> � 1, 3 <br /> epr-h of well : �, 1 ��� <br /> Depth to water. Actual purge- 7I, <br /> epth to water. <br /> Start purge 5_z Sampling time: -�- <br /> Time Temp. E. 0 pH Turbidity Volume <br /> 31 �1 t <br /> 1 OG ,'0 � 705 <br /> 1517 z� 06 103 <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 /> 0 <br /> Signature <br />